Targeted DNA sequencing of fetal cells from Papanicolaou (Pap) smears may offer an improved and earlier route to prenatal genetic screening, according to a report published online November 2 in Science Translational Medicine.

The novel strategy, which analyzes DNA from trophoblasts that have been shed into the endocervical canal (ECC), correctly distinguished fetal DNA in 20 consecutive samples. The work paves the way for an improved route to prenatal screening and testing that could begin as early as 5 weeks’ gestation.

“This would be very well accepted by physicians and patients, provided the technology is verified and endorsed as safe by a national organization, such as the [American Congress of Obstetricians and Gynecologists],” James Byrne, MD, maternal-fetal medicine specialist and chair of the Department of Obstetrics and Gynecology at the Santa Clara Valley Medical Center and affiliated clinical professor, Stanford University School of Medicine, California, told Medscape Medical News. Dr Byrne was not involved in the study.

The three types of prenatal screening tests currently in widespread use have limitations: invasiveness and use later in pregnancy (8 to 20 or more weeks) for amniocentesis and chorionic villus sampling (CVS) and low fetal fraction for cell-free fetal DNA testing (aka “NIPS” and “NIPT,” for noninvasive prenatal screening or testing).

Trophoblasts give rise to the placenta and carry the same genome as the developing embryo and fetus. Thus, probing the DNA in Pap smear trophoblasts could provide the same information as the other prenatal tests but could be performed earlier and less invasively.

In addition, the new procedure overcomes the technical challenge of zeroing in on the fetal contribution among the much more abundant maternal cells and their DNA.

“Straightforward Alternative”

Prior studies have shown that it’s possible to genotype cells in chorionic villus fragments shed into the ECC. In the new work, Chandni V. Jain, PhD, a research associate in the laboratory of Sascha Drewlo, PhD, and D. Randall Armant, PhD, and colleagues at Wayne State University School of Medicine, Detroit, Michigan, devised a “nuclear isolation protocol” to exclude most maternal DNA from ECC samples.

The initial separation, called TRIC (trophoblast retrieval isolation from the cervix), uses anti-HLA-G coated to magnetic nanoparticles to collect cells that express HLA-G, a human leukocyte antigen unique to trophoblasts and placental cells. The cells are then mounted on a slide and their nuclei isolated, which eliminates the clinging pieces of maternal DNA. Finally, the denuded trophoblast nuclei are lysed, releasing fetal DNA for analysis.

Teamed with detection of genetic markers that span the genome, the approach is “a straightforward alternative that uses a Pap smear to capture intact fetal trophoblast cells in numbers sufficient for next-generation sequencing as early as 5 weeks of gestation,” the investigators write.

The researchers probed 20 consecutive ECC specimens that included pieces of placenta, from gestational ages of 5 to 19 weeks. Beta-human chorionic gonadotropin staining identified the cells as fetal, and fluorescence in situ hybridization distinguished the X and Y chromosomes.

Targeted sequencing genotyped 59 short tandem repeats and 94 single-nucleotide variants that spanned the 24 human chromosome types. Placental DNA served as a control because it should match fetal DNA sequences.

(The paper uses the term “fetal” even for samples from the embryonic period. Reviewers advised this because that is what practitioners use when referring to CVS and amniocentesis, Dr Drewlo told Medscape Medical News.)

All 20 fetal samples matched the placental samples, indicating a high degree of discrimination of fetal genetic markers from those in the maternal genome. The average fetal DNA fraction was 92.2% ± 6.5%, indicating minimal contamination with maternal DNA. In contrast, the fetal fraction in cell-free fetal DNA in the maternal circulation at 10 weeks’ gestation is only 4% to 10%.

Noninvasive Testing an Advantage

Pap smear–based prenatal testing offers several potential advantages. A woman’s body mass index does not compromise Pap screening results, as it can the other technologies. Dr Byrne lists other advantages. “Reliable testing can be obtained earlier in pregnancy. It is noninvasive, which would provide reassurance to many patients. And it is simpler than NIPT. It has tremendous commercial potential because it would utilize existing pipelines of patients.”

One limitation of the study is the small sample size. Another limitation is a natural and not a technological phenomenon: placental mosaicism. A somatic mutation in a placental cell or a cell from the actual embryo or fetus could cause discordance, which would appear as a false negative or positive. “The effect of mosaicism is not well understood. It is a problem for all approaches,” said Dr Drewlo.

“Expect some time to allow appropriately large sample sizes to validate the technology. If it is confirmed, and then endorsed by leading organizations, then it’s easy to see the potential for rapid market dominance. This is certainly a promising report,” concluded Dr Byrne.

Dr Armant and Dr Drewlo have pending patents on the isolation and use of endocervical trophoblast cells for fetal diagnosis and have licensed intellectual property to PerkinElmer Inc. Dr Byrne has disclosed no relevant financial relationships.

http://www.medscape.com/viewarticle/871305?nlid=110427_2581&src=WNL_mdplsnews_161104_mscpedit_obgy&uac=244711BY&spon=16&impID=1228473&faf=1

Source: Medscape Medical News

GOP out of bedroomA US News and World Report article (12/31/14), What the Battle Over Abortion Will Look Like in 2015, should remind all of us concerned about reproductive justice that Republicans will control the Senate and the House of Representatives beginning this month. As much as Republicans claim to favor small and less government, we all know that when it comes to issues relative to human sexuality, they espouse as much government intrusion and regulation as possible. Although many Republicans are pro-choice, the party continues to allow its extreme right wing and Tea Party darlings to steer the votes and priorities. Reproductive decisions, sexual orientation, and even personal sexual activity preferences are of greater concern to John Boehner, Mitch McConnell, and friends than ensuring that every child has food to eat, that people are working and earning a fair wage, or that the U.S. government is protecting business from cyber-attacks, and so on. It makes no sense, but it is a reality.  It is reasonable to expect more attacks on reproductive rights in 2015.

Rick BrattinThe Republicans are on a roll. Just last month Missouri Republican Rick Brattin reintroduced a bill to require women seeking abortion to get permission from the father of the zygote/embryo/fetus.  According to Mother Jones, Brattin’s bill would exempt “legitimate rape” victims. For a pregnancy resulting from rape to be exempted and the claim of rape “legitimate,” a police report must have been filed immediately after the rape. Oh yes, the Republicans are on a roll, seemingly even including distinctions about rape – Todd Akin style. Always claiming that the legislation is to “protect women,” these mostly male representatives apparently believe they know more about what is best for women’s health than, well, legitimate women.

Thomas State legis LoCPro-choice Americans have got to step up to the plate in 2015.  They must resolve to at least let their elected
representatives know their views. As fellow blogger and former lobbyist Pat Richards can confirm, it is very easy to contact members of Congress.  One website that provides direct contact information of each congressional member is https://www.congress.gov/members. For state and local legislative representatives, The Library of Congress Thomas website provides links to each state legislature. Pro-choice people need to take a page from the playbook of the zealously anti-choice organizations like violence-promoting Operation Rescue and the various evangelical groups that pressure church members to attend sessions to write emails and make phone calls en masse. It can make a difference in the extent to which a member of Congress maintains interest in sponsoring or defending restrictive anti-abortion or other family planning legislation.

During my years directing a clinic, countless state and federal legislators shared with me that the primary reason they hesitated to have a stronger public pro-choice position was because they seldom heard from their pro-choice constituents, but they constantly heard from the anti-abortion groups. That needs to finally change – there is too much to lose if it does not.  While NARAL and Planned Parenthood supporters often initiate outreach activities, they simply cannot compete with the church-sanctioned and sponsored groups in terms of numbers. It is also worth noting that politicians actually like to hear the views of individuals speaking from the heart instead of an organized script.

minds changeAs much as we may see reproductive rights as an issue in which people do not change their positions, there are studies that illustrate that people do change their minds about polarizing issues such as abortion and gay rights. Minds change through personal experience or learning about the firsthand experience of someone they know, love, or in some way care for. Minds can change when we interact with others with whom we share general values and recognize that on polarizing issues with which we disagree, things are not so black and white, all or none propositions. No one should be fooled into believing that when minds change about abortion it is only to the anti-choice position. National Right to Life has done some great messaging in that regard. In fact, pro-choice groups could do the same.

Maria Rivera

Maria Rivera/Photo from Trust.org

In 2015 we can probably expect to see more legislation proposed to ban abortion as early as 12 weeks, more verbatim scripting for medical professionals to impose on patients regardless if true, and more unnecessary and invasive ultrasound or other testing. Before you know it, every woman who miscarries will be subjected to a law enforcement report and inquiry. Think that sounds extreme? Just take a few minutes to learn about Maria Teresa Rivera in El Salvador where all abortion is banned. She did not even know she was pregnant when she miscarried, but the judge did not believe her and sentenced Rivera to 40 years in prison for aggravated murder. Each and every anti-abortion bill proposed in the U.S. under the guise of women’s health is another step towards a total ban.

Time is of the essence for reproductive justice. When and whether to have children is a personal choice. Abortion is a personal choice in which women do not benefit from, and can be harmed by, governmental interference. Medical professionals do not need the input of politicians in the private relationships they have with patients. Please, be it resolved that you will share your pro-choice position and dedication to reproductive justice with your elected representatives beginning this first month of 2015.

A while back, a friend of mine claimed that every increase in fetal rights is necessarily accompanied by an accompanying loss in women’s rights. I agreed with the principle, but the word “autonomy” has been so often repeated, and so often debased, that it now holds little power without a stark example to illustrate its meaning. Such a stark and powerful example is now available, and the subject of massive media attention, a federal lawsuit, and national outrage, as reported recently by the New York Times.

The basic facts of the case: early into her second trimester, Wisconsin native Alicia Beltran disclosed a former pill addiction at a prenatal checkup, an addiction she had overcome on her own prior to becoming pregnant. Her doctor did not believe her, despite a urine sample negative for the drug taken the same day, and two weeks later a social worker arrived at her home and insisted she voluntarily restart Suboxone treatment to wean herself from the drug or face court-ordered treatment. (She admits she shut the door in the social worker’s face after saying “Maybe I should just get an abortion.”) Two days after that encounter, sheriffs arrived and escorted Ms. Beltran to a hearing where her fetus had been appointed a lawyer, but she had not. On the written advice of Dr. Angela Breckenridge, obstetrician at a subsidiary clinic of St. Joseph’s Hospital, in which she noted “[The patient] exhibits lack of self-control and refuses …. treatment” and recommended “mandatory inpatient drug treatment …. or incarceration,” Beltran was given the choice between imprisonment and a treatment program. She chose the latter, and was held there for 78 days, during which time she lost her job.

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Unfortunately, while this case reaches national attention and is now the subject of a federal suit asserting the unconstitutionality of the law, it is not an isolated incident. Rather, a growing number of cases reflect the results of similar laws that grant fetuses rights as individuals, which for women has meant hundreds of cases of forced treatment (including surgery), detainment, and criminal charges during pregnancy or following birth.

National Advocates for Pregnant Women (NAPW) published “Arrests of and Forced Interventions on Pregnant Women in the United States, 1973-2005,” a comprehensive review of cases in which pregnant women were deprived of their physical liberties in some manner in the name of fetal rights or health. It reported 413 cases, which the authors considered to be a strong underestimation of the true number, as searching public databases for certain kinds of cases (eg unpublished Native American tribal court decisions or hospital detentions that did not merit media coverage) was virtually impossible. If you take away nothing else from this article, I suggest you give that paper (below) a read. It is harrowing.

Pro-life groups have rallied behind such laws, as they represent a small precedent in the legal war to recognize the fetus as a full person. As is somewhat common for such groups, they paint it as a step towards improving the health of both mother and fetus. The legislative director of Wisconsin Right to Life described the intent of the law that detained Beltran for over two months as “help [for] both the woman and her baby.”

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That is not the case.

To view these kinds of cases in their proper context, we must look to both medical ethics and the scientific literature. As far as medical ethics quandaries go, cases like Beltran’s bring up two principles: 1) patient privacy, and when physician disclosure of patient information is warranted, and 2) right to refuse treatment.

First, patient privacy is a very central tenet of medical practice, holding not only ethical weight but legal weight as well. Typically, the only exceptions that justify disclosure of private patient information are reasonable suspicion of imminent harm to others (normally this applies only to psychiatrists with disclosures of intent to commit violence), health defects that render potential harm to others (such as epilepsy in the case of professional drivers), certain reportable sexually transmitted diseases, abuse, and gunshot or knife wounds. Laws vary slightly from place to place.

However, the vast majority of states do not hold potential harm to a fetus to be a concern strong enough to override patient privacy, for very good reasons. The logic is supported not only by legal reasons (with very few exceptions, legal precedent holds that a fetus is not entitled to the legal rights of a full person on par with the mother), but practical ones as well.  The American College of Obstetricians and Gynecologist’s Committee Opinion report “Substance Abuse Reporting and Pregnancy” states that “Incarceration and the threat of incarceration have proved to be ineffective in reducing the incidence of alcohol or drug abuse … [in part because] Substance abuse reporting during pregnancy may dissuade women from seeking prenatal care.” For the tiny minority of states that enforce such laws, the report recommends that physicians “work with state legislators to retract [such] legislation.”

The report also notes that punitive treatment of substance abuse inappropriately treats addiction or suicide attempts as moral failings rather than addressing underlying issues or attempting to treat them appropriately. Lastly, it assumes that women have not already sought treatment (drug treatment programs specifically tailored for or preferential for pregnant patients are uncommon in the US).

In an amicus brief opposing the South Carolina Supreme Court’s decision (Whitner v South Carolina) to extend child abuse and neglect laws to viable fetuses, the South Carolina Association of Alcoholism and Drug Abuse Counselors (SCAADAC) noted that enrollment by pregnant women in drug and alcohol treatment programs in the state dropped by 80% in the year following Whitner’s highly publicized prosecution and leading up to the court’s decision to uphold it. This suggests that pregnant addicts are not only deterred from seeking prenatal care out of fear that their physicians would report their drug abuse (as physicians would legally be required to do following the ruling) but also from seeking drug addiction therapy independently.

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 Moreover, the punitive treatment of pregnant women may be even more counterproductive than as a deterrent to care, if its stated goal is the protection of the fetus. NAPW’s review describes the arrest of Martina Greywind 12 weeks into her pregnancy for “reckless endangerment” following the inhalation of paint fumes; after two weeks in the County Jail, she received a release for a medical appointment, at which time she received an abortion so that the charges could be dropped (which they were). When a law passed ostensibly to protect fetuses coerces women into obtaining an abortion to avoid criminal charges, “counterproductive” may be an understatement.

The second medical ethics principle at stake in this discussion is right to refuse treatment. This right is basic to patient autonomy, basic to respect for patient decision-making, and typically upheld for all patients with mental capacity even when the decision will inevitably result in their death. (The main, and in most places, only exception is the life-saving treatment of patients following suicide attempts, even over their objections.) In most states, the right of a pregnant woman to refuse treatment indicated for the fetus has been strongly affirmed, even at later time-points in the pregnancy.

While it is harrowing to imagine that a refusal to undergo a Caesarian section to save a viable fetus would result in the infant’s death, the alternative of court-ordered forced surgery in an emergent situation deprives a woman of her due process rights as well as her physical liberty. Moreover, court orders to force treatments on pregnant women who have refused them are often made based on dubious evidence and/or for risks that do not materialize.

NAPW’s review describes the case of a woman in Florida, who was in labor at her home when her doctors sought a court order to force her to undergo a C-section, as they felt a vaginal birth might pose a risk to the fetus (due to a prior C-section). A sheriff arrived at Pemberton’s home, strapped her legs together, took her into custody, and forcibly transported her to the hospital, where lawyers argued on behalf of the fetus in an emergency hearing. Pemberton and her husband were not appointed a lawyer or represented in the hearing, violating her due process rights in an example even more extreme than Beltran’s case. The state forced her to undergo the procedure, and when she sued afterwards, a federal district court ruled that her 1st, 4th, and 14th amendment rights were all outweighed by the state’s interest in the preservation of the fetus’ life. It should be noted that she successfully gave birth vaginally to three more healthy children following the surgery ostensibly so necessary to saving the fetus due to the dangers of a vaginal birth.

Lastly, criminal action against pregnant women or new mothers is often based on faulty or non-existent evidence of a causal link between the woman’s action (or inaction) and the supposed harm it is claimed to have caused. Two thirds of the cases reported on in NAPW’s review did not even result in an adverse pregnancy outcome. (In fact, it’s worth noting that the South Carolina Supreme Court’s Whitman ruling does not even require evidence of actual harm to prosecute, but can be applied to the mother of even a healthy newborn if it tests positive for drugs, since she “risked” a poor pregnancy outcome with drug use.) The majority of the cases studied in the review reflected criminal prosecution of women who had purportedly used cocaine during their pregnancies, and indeed the legislation in Wisconsin is popularly known as the “cocaine mom” law.

However, despite studies showing that cocaine is linked to short term negative effects such as low birth-weight and preterm birth, longer-term studies have actually indicated little to no significant evidence of more permanent effects on children (contrary to popular belief). A review of 32 articles concerning long-term effects of prenatal cocaine exposure revealed that it is not significantly correlated with defects in “physical growth, developmental test scores, or language outcomes.” Ironically, prenatal care—which criminal liability laws act as a deterrent for pregnant women to seek—has been shown to minimize the impact of drug use on perinatal outcomes.

So how are so many women being affected by prosecution in such cases, when little evidence actually supports the claims made against them? It is best explained by the fact that poor women are disproportionately affected by such laws. 71% of the women in NAPW’s review “qualified for indigent defense,” and a 2010 article published by the National Association of Criminal Defense Lawyers indicates that arrests of pregnant women are too often supported by “medical misinformation,” and that the public defenders of such women are guilty of ineffective counsel when they fail to counter scientific misinformation or allow trials to proceed without any expert testimony whatsoever.

And that’s if the mother is appointed a lawyer at all. Cases of emergent forced medical interventions like Pemberton’s, in which the fetus is appointed counsel and the mother is not, are harrowing in their implications. The federal court’s decision not to uphold Pemberton’s claim that her constitutional rights had been violated because they had been superseded by those of her fetus affirm—frighteningly—that pregnant women are not party to the same constitutional rights as virtually everyone else in the US population.

In sum, it is starkly clear that laws used to prosecute pregnant women or new mothers for substance abuse or to detain or force treatments on women who refuse advised medical treatments have very disturbing implications for the constitutional and medical rights of pregnant women. Cases such as these illustrate very clearly why fetal personhood measures not only harm women, but are counter-productive in that they may encourage poor fetal outcomes when women avoid prenatal care or drug treatment, or even seek abortions, for fear of criminal prosecution.

 

For more:

1) NAPW’s review, “Arrests of and Forced Interventions on Pregnant Women in the United States, 1973-2005: Implications for Women’s Legal Status and Public Health” http://jhppl.dukejournals.org/content/38/2/299.full.pdf+html?sid=b0811f36-d4e4-4b51-a830-e175e6eee40c 

2) The NY Times article on Alicia Beltran: http://www.nytimes.com/2013/10/24/us/case-explores-rights-of-fetus-versus-mother.html?pagewanted=1&_r=0

3) Another NY Times article on the trend of criminalizing pregnant women or new mothers for drug abuse: http://www.nytimes.com/2012/04/29/magazine/the-criminalization-of-bad-mothers.html?pagewanted=1&_r=0

4) ACOG’s Committee Opinion, “Substance Abuse Reporting and Pregnancy: The Role of the Obstetriction-Gynecologist” http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Health_Care_for_Underserved_Women/Substance_Abuse_Reporting_and_Pregnancy_The_Role_of_the_Obstetrician_Gynecologist

5) The National Association of Alcoholism and Drug Abuse Counselors’ Amici Curiae brief on the Whitner v South Carolina case: http://www.drugpolicy.org/docUploads/Whitner_NAADAC_Amicus.pdf

6) An article on perinatal effects of gestational cocaine use: http://www.ncbi.nlm.nih.gov/pubmed/21257143

7) A review of long-term effects of prenatal cocaine exposure: http://pediatrics.aappublications.org/content/125/3/554.full.pdf

8) An article on the effects of prenatal care for drug-abusing women on perinatal outcomes:  http://www.ncbi.nlm.nih.gov/pubmed/12847528

9) An article on poor representation and legal prosecution of pregnant women: http://www.hivlawandpolicy.org/sites/www.hivlawandpolicy.org/files/Pregnant%20women%20junk%20science%20and%20zealous%20defense.pdf

 

 

If you have been following my recent posts, you know I am supporting the Abortion Rights Freedom Ride set to kick off on 23 July 2013 in New York City and San Francisco.  I discussed this summer’s action with a number of people I respect, and there is a divide in the abortion rights community on whether or not it is wise to embark on this action.  I did not reach the decision to support and join with the Riders without giving the decision due diligence; nor, did I neglect to consider the multiple outcomes of the action.

When facing a dichotomous debate among two sides of the community, two camps who should be working together toward common goals, I ask myself now as I did in the past, What Would Dad Do?  Would he shrink back into the shadows, rely solely on private action and influence, or would he advocate, and actually engage in, direct action and response to those who tormented, stalked, and eventually killed him?  Obviously, we know the answer:  he did not back down!  As I wrote a couple of posts ago, I also cannot and will not back down.

Upon the 20th year after my dad’s murder by a Christian terrorist, as we face continued threat of violence, and as state after state passes draconian anti abortion legislation, I reflect not only on what my dad would do but also consider the words of Yeats:

Things said or done long years ago,
Or things I did not do or say
But thought that I might say or do,
Weigh me down, and not a day
But something is recalled,
My conscience or my vanity appalled.

Knowing I will be appalled by remaining silent, I resolved the vacillation by opting to support what I believe is the right course of action.  To that end, I co-authored a piece on the merits and need of the Abortion Rights Freedom Ride with one of its primary organizers Sunsara Taylor.  I want to share with you our recent missive so perhaps more of us will come together on the need for direct, vocal, and mass support our clinics, our doctors, and our rights

Abortion Rights Are At a Crossroads:
This is NOT a Time to Lay Low – It is Time for Massive Uncompromising Struggle!

By Sunsara Taylor and David Gunn, Jr.
July 12, 2013

Across the country, people are waking up to the state of emergency facing the right to abortion. As legislators in Texas push hard to close down 37 of 42 abortion clinics statewide, new laws in North Carolina would close four of their five remaining clinics. Meanwhile, Ohio’s recently passed budget could close as many as three abortion clinics. North Dakota, on August 1st, may become the first state to effectively ban abortion. Already Mississippi’s last abortion clinic is merely an appellate ruling away from closure. We could go on.

If we do not reverse this trajectory now, we will condemn future generations of women and girls to forced motherhood, to lives of open enslavement, terror, and life-crushing shame. Women will be forced to have children they do not want, trapping them in abusive relationships, driving them into poverty, forcing them out of school, and extinguishing their dreams. Women will go to desperate and dangerous measures to terminate unwanted pregnancies, once again flooding emergency rooms and turning up dead women in cheap motels with blood caked between their legs.

We face two divergent roads: Either we seize control of the debate and reset the terms and whole trajectory of this fight; or we continue down the road of “established conventional wisdom,” only to awaken before long to an unrecognizable and untenable situation for women. What each of us does matters,and matters tremendously.

It is in this context that we initiated an Abortion Rights Freedom Ride. Our echo of the Civil Rights Freedom Rides is intentional and fitting. Women who cannot decide for themselves if and when they have children are not free. On the contrary, they are mere child-bearing chattel whose purpose is to serve and not actively chose their destinies.

Volunteers on this Freedom Ride will caravan from both coasts to North Dakota, traverse through the middle of the country into Wichita, and head due south to Jackson, Mississippi. Our aim is threefold: one, we must move beyond localized fights andlauncha national counter-offensive; two, we must radically reset the political, moral, and ideological terms of this fight so that millions understand that this fight is about women’s liberation or women’s enslavement; lastly, and of paramount importance, we must call forth the mass independent political resistance that is necessary to defeat this war on women.

As the Abortion Rights Freedom Ride evolved from conception to genesis, many have responded by with enthusiastic and unequivocal support. Regular people from across the country as well as those who have been on the front lines of the abortion rights struggle are joining with us in demanding abortion rights without compromise and thanking us for daring to travel to where women’s rights face harshest threat.

However, some who share our passion for the cause have raised concerns and even opposition to this action. They fear the Abortion Rights Freedom Ride will be too confrontational, too vociferous for abortion, and may turn off avenues of support.
Some have argued that it is wrong for people to come into local areas from the outside. Others argue that mass political protest will endanger the chances of winning important court cases and that it is better to rely on official channels of politics.

Because the future of women is at stake, we feel it is critical to address these concerns head on. In fact, it is exactly the faulty logic at the root of these concerns that has contributed to all of us finding ourselves in such a dire situation.

First, while local ground conditions are different and unique in some ways, the fact that every clinic and every state is facing heightened assault is not unique nor is it local. We all face a national assault on abortion rights which requires a national counter-offensive. Not only is it utterly immoral for us to abandon the women living in the states most under direct duress, it is delusional to think that what happens in states like Arkansas, Mississippi, North Dakota and Kansas will not come soon to a theater near you. Our futures are bound together and we all share the responsibility to take this on and turn the tide where the attacks are the most severe.

Second, while it is true that a great many people – including many who support abortion rights – are defensive about abortion, they should not be ashamed and this defensiveness and shame is precisely something we must eradicate.

Among the reasons many are defensive about abortion are decades of propaganda by those who oppose women’s equality but posture as defenders of “babies”; meanwhile, supporters of abortion rights have too often been conciliatory, muted, and compromising. This must stop. This fight has never been about babies. It has always been about controlling women. This is why there is not a single major anti-abortion organization that supports birth control.

If we want to turn the tide, we have to tell the truth: there is absolutely nothing wrong with abortion. Fetuses are NOT babies. Abortion is NOT murder. Women are NOT incubators.

A great many people are hungry for this message. They are furious and searching for a meaningful vehicle to make their outrage felt. It is only by asserting the positive morality of abortion rights that we can call forth and mobilize the tens of thousands who already share our resolve. Only through direct action and a polemical shift can all of us stand together and change how millions of others are thinking. Shouldn’t this emergency situation awaken us to the need to change public opinion, not accommodate it?

History has proven that directly confronting oppressive social norms can be disruptive and scary; yet, it is a necessary and uplifting part of making any significant positive change. Many argued that it was wiser for LGBT people to stay closeted until society was more accepting; others counseled against the Civil Rights Freedom Rides out of fear that it would only rile up the opposition, but it was only when people took that risk and got “in your face” that broader public opinion and actions began to change.

We must create a situation where being anti-abortion is seen to be as socially unacceptable as it is to advocate lynchings, anti-LGBT violence, or rape (although, if you listen to some on the Right, rape advocacy is not necessarily off their table).When we reach that summit, we will be on our way to turning the tide.

Third, while court cases are important – even essential – it is only through truly massive independent political struggle that we stand a chance at defeating the truly unyielding and powerful foe we face. Every setback the anti-abortion movement experiences only makes them more determined and every victory only makes them more aggressive. They will not be appeased if we lie low. No court case or election or new law will stop them. Not only has the existing power structure proven unwilling or unable to do so, people who believe they are on a “mission from God” are not bound by human laws and do not yield to public opinion.

But they can be defeated. Forced motherhood is deeply opposed to the interests of humanity. If we get out there and tell the truth, if we resist, if we clarify the stakes of this battle, and if we mobilize wave upon wave of the masses to get off the sidelines and into the streets with us, we can win. There is a tremendous reservoir of people who can and must be called forth to join in this struggle. We have seen this vividly in Texas. Let us not underestimate the potential that exists in every state across this country.

We stand at a crossroads. For the future of women everywhere, let us refuse the worn pathways that have allowed us to lose so much ground. We must not lay low, hope these attacks will blow over, and allow women in some parts of the country to be forced into mandatory motherhood while hoping to preserve the rights of a shrinking few. We cannot continue to foster the attitude that abortion is the 21st Century’s Scarlet Letter while allowing abortion providers to be further stigmatized and demonized. We cannot recoil from the massive fight that urgently needs fighting at this moment in this time.

Now is the time for courage, for truth telling, for stepping out and launching an uncompromising counter-offensive. We have right on our side. We call on everyone who cares about the future of women to join with us in strengthening the national impact and influence of this Abortion Rights Freedom Ride. Join with us at our kick-off rallies in New York City and San Francisco in July 23. Caravan to meet us in North Dakota, Wichita, Kansas, and Jackson, Mississippi. Send a donation or a message of support. Reach out to individuals and religious communities that can provide safe passage to the courageous individuals who are giving up their summers and putting everything they have into winning a different and far better future for women. Most importantly, let us together take the rough road to victory. It may be less traveled, but only through struggle can we reap the benefits of love’s labor won.

To learn more about and get involved with the Abortion Rights Freedom Ride, go to: http://www.stoppatriarchy.org/

Sunsara Taylor writes for Revolution Newspaper (revcom.us) and is an initiator of the movement to End Pornography and Patriarchy: The Enslavement and Degradation of Women (StopPatriarchy.org)

David Gunn, Jr. is the son of David Gunn, Sr., the first abortion doctor to be assassinated by an anti-abortion gunman, and blogs for Abortion.ws

Abortion

Abortion

My head has been spinning lately as I try to keep up with all of the anti-abortion legislation that has flying back and forth in various state legislatures.   For example, at this point fourteen states have trotted out measures to ban abortion prior to “viability” — the point at which a fetus could survive outside the uterus. These measures take three forms: banning all abortions, banning abortions at some point in the first trimester of pregnancy and banning abortions at 20 weeks after fertilization.

In addition, there are bills preventing employees of abortion clinics from providing sex education in schools, banning tax credits for abortion services and requiring clinics to give details to women about fetal development and abortion health risks. There’s also a ban on abortion based solely on the gender of the fetus.

The most interesting law to me is the one in North Dakota which prohibits abortions from being performed after six weeks.  Think about that one for a second.  Hell, how many women even know they are pregnant after six weeks?   And, I am not a doctor but I seem to recall that some abortion clinics would not perform an abortion that early for fear that they might not get all of the tissue.

The pro-choice movement has a right to be very concerned about this trend in the state legislatures.  The anti-abortion movement is feeling their oats and they are clearly consulting with each other, photocopying the bills that passed in other states and pushing it in theirs.  And in many of those states, they’ve got the majorities so there ain’t much that we can do about it (except fundraise).

Abortion

Abortion

There is hope, however.  And it comes from the offices of the Center for Reproductive Rights and the ACLU Reproductive Freedom project.

For 20 years, the Center for Reproductive Rights has used the law to advance reproductive freedom as a fundamental human right that all governments are legally obligated to protect, respect, and fulfill.  They are an aggressive bunch of lawyers who are usually the first to jump in when some whacky anti-abortion bill is signed into law.  Within 24 hours, they are at the court filing for an injunction in an effort to prohibit the law from taking effect.

The ACLU believes that the decision whether or not to carry a pregnancy to term is essential to women’s equality, autonomy, and dignity, with implications for every aspect of her life – her educational aspirations, career goals, economic status, and, more broadly, her ability to live the life she planned.   Like the Center, the ACLU’s cadre of attorneys is working on a myriad of issues related to abortion.

Make no mistake about it, folks.  The action is now swinging to the courts.  Most of the legislatures have done their dirty work for this year and these two groups will now challenge most of those laws as they have been doing for many years.

But I would be remiss if I did not mention that the work these groups perform costs money.  Lots of money.  Heck, didn’t you see “Erin Brockovich?”   Remember how much that case cost?   Well, these two groups face the same daunting task.  They go into these cases and spend a lot of money with no guarantee that they’ll win and/or get attorneys fees at the end.  And if anyone thinks that the abortion clinics have that kind of money to fight these laws, think again.

So, if you are thinking of sending a dollar to some pro-choice group, you might think about these two organizations because, until we can change the legislatures in some of these ass-backwards states, the only defense we have against these attacks is in the courts.

No More Bullying Abortion Facilities

About ten years ago, I attended the funeral of Norma Stave, a good friend who, with her husband Carl, was the co-owner of two abortion clinics in Maryland.  Carl was the main physician who performed the abortions.  When I arrived at the church, Carl came up to me and asked at the last second if I would deliver a eulogy.  I had always been comfortable talking in front of audiences but this was a different animal.  Still, I was able to get through it, using my few minutes to praise Norma for her devotion to women in need.

Skip ahead a number of years.  Carl died shortly after Norma and their son, Todd, ultimately became the landlord for their two buildings.  About eight months ago, Todd’s clinic in Germantown, Maryland attracted national attention when they hired Doctor Lee Carhart, a physician who worked for the late George Tiller and who vowed to continue George’s work by offering late term abortions.

Victim of Anti-Abortion groups

Victim of Anti-Abortion groups

Soon thereafter, local anti-abortion advocates learned that Todd owned that building where Lee worked.  They quickly organized a number of protests, accomplished their goal of getting publicity in the local papers and have been a continual presence ever since.  Then, looking for another angle to get their names in the papers, they decided to crawl deeper into the gutter.  They learned where Todd’s 11 year old daughter was going to school and at a Back to School night, they stood outside the school with a banner that read “Please Stop Killing the Children” and the usual photos of aborted fetuses.   Then, these wackos actually put Todd’s picture, phone numbers and email addresses online and urged their followers to contact him with their “prayers.”  Todd was inundated with calls and emails.  Nice, huh?

But Todd decided to fight back.  He compiled a list of the people who were calling and emailing him and he sent that list out to 20 of his friends, urging them to call those people.  He told them to not argue with them, to just be polite and tell them that “the Stave family thanks you for your prayers.”  Well, those 20 friends passed on the info to their friends, and so on and so on and within two days they had 5,000 pro-choice folks making calls.  Interestingly, the calls and emails to Todd’s house came to an abrupt halt.

Hmmmmmm…Is Todd on to something here?

Abortion

Abortion Rights

I talked to Todd last night.  He tells me that he has actually established a group called “Voice of Choice” (www.VoChoice.org) which seeks to organize a “person to person counter campaign against anti-choice bullying.”  The people who volunteer are notified when a certain anti-abortion advocate is harassing a doctor and are given that person’s phone and/or email.  Then they start contacting that person.  Todd says they have successfully stopped the harassment in two cases already.

I have no doubt that there are some pro-choicers out there who might feel uncomfortable about stooping to the tactics normally used by the anti abortion folks.  Indeed, whether or not to use these kinds of aggressive tactics has been the subject of many conversations within the pro choice movement for years.  In fact, Todd told me that some national pro-choice groups have been reluctant to cooperate with his organization.

When I was in the movement, I always came down on the side of those who did not support stooping to their level.  I thought it was beneath us, that we had to take the high road.  And maybe I’m just getting old and cranky.  But now I say screw it.  As long as it’s legal, go get the bastards, Todd!

Empty Press Conference Room

About a year after we formed the National Coalition of Abortion Providers, its members decided it was time to hold their first conference.  For years, many of them had been attending regular conferences hosted by the National Abortion Federation but some of the NCAP members were not members of NAF and the NAF meetings tended to focus on the medical side of the abortion issue.   The folks who belonged to NCAP believed strongly in having a political voice on Capitol Hill.  They argued that while NARAL was focusing on the general right to abortion, they needed someone to educate the Congress on the issues of direct importance to abortion doctors and clinics.

So, we booked the new Hilton Hotel in Alexandria, Virginia, put out the suggested agenda and kept our fingers crossed.  Like anyone

who is putting on a party, we were very nervous that no one would show up.  But, much to our surprise, about 70 clinic staff, owners and doctors came to Alexandria for the two day affair.  Two of the attendees were Doctors George Tiller and Bart Slepian, who both would ultimately be murdered by pro-life activists.

To highlight how NCAP was already establishing a presence on Capitol Hill, we persuaded Virginia Congressman Jim Moran, a leader of the pro-choice movement, to kick off the event.  Jim gave a rousing speech to a crowd of people, many of whom had never even met a real live Congressman.  The next few hours were devoted to public relations and business issues.  For example, we discussed how to conduct an “open house” for abortion clinics and where to get the best malpractice insurance.

The highlight of the meeting, however, was the adoption of NCAP’s first resolution.  At that time, the clinics were under siege legislatively on both the national and state levels.  It seemed that every day a bill was introduced requiring parental consent for minors, a 24 hour waiting period, the distribution of fetal development brochures, etc.  At one point, however, an NCAP member suggested that those who were introducing these bills really had no idea how clinics opera

Proud Providers

ted to begin with and how women approached the decision.  So, the members decided to adopt a statement which made it very clear how clinics operated and how patients were treated.  So, for example, they noted that 95% of minors already talked to their parent or parents, that women DID wait at least 24 hours from the time they decided to have an abortion and that the clinics were already subject to many federal and state regulations.

The resolution was adopted unanimously and we decided to have a press conference on Capitol Hill the next day.  We quickly hired a public relations firm to get the word out.  Besides the resolution, their pitch was that this would be a

chance for the press to see in person the owners, doctors and staff who actually worked in abortion clinics.  This was a “coming out party” of sorts for our folks.

The next day, about 30 members of NCAP, all dressed up in their best Capitol Hill attire, took taxis to the House Cannon Office Building and walked into the ornate Post Office and Civil Service Committee Room, ready to conduct their press conference.  But as we walked through the large mahogany doors, we entered an empty room.  Not one member of the press showed up.  We had given a press conference and no one came.  I was totally ticked off but the NCAP members were just thrilled to be in the room and when a young media student from Georgetown University came walking in with his little camera, they agreed to stand behind the podium and make their statements.

To this day, I’ll never forget them standing there, facing that one camera, looking very proud that they had adopted this resolution and were finally showing their faces to the public.  It was just one camera but for all they knew, they could have been talking to CNN.

Abortion Clinic Bombed

I was talking to an old friend of mine yesterday, a doctor who used to perform abortions in the Midwest years ago.  He retired in 2004 and in the course of the conversation we started talking about, as he put it, the “wild west days” when the bullets were flying and the bombs exploding at abortion clinics all across the country.  He then expressed his concern that the younger activists do not remember or just simply did not know what was going on in this country at that time.

As a staff person for the National Coalition of Abortion Providers, I was in the middle of it all.  Our office served as one of the “command posts” that sprung into action when the crap hit the fan.  The minute we got the news about a shooting or any other kind of violent act, we would send out an “Emergency Fax” to all of our clinics alerting them about the incident.  The main reason why we did this was to simply let them know that one of their colleagues had been involved in some heinous act and more often than not the other clinics would communicate their concerns and well wishes to their friends who had just joined the growing number of victims of anti-abortion violence.  In essence, we generated a nationwide group hug.

After talking to this doctor, I started to think about the particularly “bad” years and 1997-1998 was a period that really stuck out in my mind.  Yes, by that time several doctors had been murdered and other acts of violence had been committed, but this time period was a particularly bad one:

In January, 1997, a bomb exploded outside an office building in Atlanta that housed an abortion clinic.  Then, an hour later, while the police and rescue workers were still on the scene, another bomb exploded near a trash can. Seven people were injured;

In March, a Molotov cocktail was thrown into the window of Family Planning Associates and an anti-abortion advocate drove his truck through the doors of another clinic in the area.  Two weeks later, four fires were set on the roof of the Mountain Country Women’s Clinic in Montana;

In May, an arsonist drove up to the Lovejoy Surgi-Center, ran a hose from a metal drum containing an unidentified flammable liquid into the clinic and ignited it.  A month later, an incendiary device was thrown through a hole cut into the air conditioning duct on the roof of the West Alabama Women’s Center;

A few months later, a bomb exploded at the New Woman All Women Health Care in Alabama killing an off duty policeman and critically injuring a nurse.  Five months later, in the space of one week there were eight butyric acid attacks on clinics in Florida.  In these cases, the assailant injected the acid into the clinic using a syringe and because of the horrific and noxious smell, the clinics had to be evacuated, washed down and closed for several days.  This incident started a spate of similar attacks over the next few months;

Towards the end of 1998, my good friend, Doctor Barnett Slepian, was murdered in upstate New York when anti-abortion activist James Kopp fired a shot through a window in his house.

This list is, of course, a small sampling of what was going on in those days.  And, as I read this list and recall the people involved, I honestly do get chills.  I can remember the fear, the loss, the insanity and the sense of helplessness that overwhelmed all of us.

Today, there is less violence when compared to those days but that is no consolation.  History can repeat itself and so every so often I intend to write about an incident or two in more detail in the hopes of reminding those coming up behind us of the sacrifices made by the doctors, the staff and others in defending the right to choose abortion.  I also look forward to seeing our friends in the pro-life movement condemning the violence.

Rhythm Method otherwise known as "Keep Your Fingers Crossed"

I’m not gonna talk about abortion today but I am still pretty confident that this will generate our usual exciting discussions!

A relative of mine lives in Tennessee.  He is 31 years old, has a lovely wife and makes a good living as an attorney for a big law firm.  He and his wife are very devout Catholics and faithfully adhere to all of the rules and regulations, including the one that basically says you should only have sex to procreate.  They say they use the “rhythm method,” which I frankly don’t know if the church condones or not.  But, basically, that’s their form of “birth control.”

Well, it ain’t working very well because in the last 6 years, they’ve had four children.  And I just learned that they are now expecting baby number five!  But when I saw them this weekend, I could not bring myself to congratulate them because I believe that producing five children is a very selfish act.

Now, they have enough money to raise the kids in a nice setting.  We do not have to worry about them sopping off the public dole.  And the kids will probably grow up to be productive citizens, although – yes – it is possible that one or two of the five might wind up being drug dealing psychopaths.  But, let’s be optimistic and say that they will all grow up to be wonderful pillars of society.

Here’s the problem.  The Catholics who read and comment on this blog believe that their religion is “the word,” that all of the other religions don’t have much to offer and, indeed, are way off base.  This not only relates to the issue of abortion, but to so many other issues that the church pokes its nose into.  But if it were up to many Catholics, we would all sign up with their church and join them in following the dictates of the Pope, like lemmings to the sea.  And, if we all did that, we’d all be producing 5, 6, 7 kids.

And while each one of those kids might be a “blessing,” as many suggest, I still think that having that many kids is a selfish act.  Many years ago, when we had an infinite amount of resources and it actually was helpful to have a crap load of kids

Catholic Model

working the family farm.  But that’s not the world we live in anymore.  We are using up all of our food, our water and other natural resources at an alarming rate.  Oh sure, those of you reading this might be sitting in a nice comfortable heated house but take a minute and read about the rest of the world, especially the Third World countries.

The point is that if every woman becomes a breeder reactor, the plethora of children they produced will be adversely affecting the world that my TWO children are living in.  That’s because we share the same planet, we breathe the same air.  We can just simply no longer afford to be propagating at a pace like this young couple.

And, let me throw in this wrench:  if I told you the same story and the woman was an illegal immigrant and crack addict living on welfare in the Bronx, would you still be saying that her sixth child was a “blessing?”