Frances Kissling, You Confused Lioness, You

So many excerpts, so little time (via Amanda. Thank you, oh so much, for making me read this.):

If abortion is a morally neutral act and does not endanger women’s health, why bother to prevent the need for it? After all, the cost of a first-trimester abortion is comparable to the cost of a year’s supply of birth control pills — and abortion has fewer complications and less medical risk for women than some of the most effective methods of contraception.

First, abortion, like any other MEDICAL PROCEDURE known to humans, is associated with risks. Just because carrying a pregnancy to term and delivery pose a higher risk to a woman's health vs. terminating a pregnancy, that in no way magically transforms abortion into a risk-free procedure. And, just for future reference, the risks/benefits of a medical procedure exist independent of whatever morality one decides to assign to it.

Second, not only is the birth control pill not one of the most effective methods of contraception, it's not even part of the "most effective methods" group. [Within the first year of use, the Pill has a ~5% failure with typical-use.]

The most effective methods are Implants (0.05% Norplant [~0.3% Implanon]) and IUDs (0.1% Mirena [0.8% CuT]), followed closely by male sterilization (0.15%), and Depo-Provera (0.3%). [Just to give you an idea of risk, the chance of death, per year, is 1:263,000 per early first trimester abortion, 1:10 million for IUD use, and 1:1 million for undergoing vasectomy.]*

Third, so, why should we bother to prevent the need for abortion? Who says we should? Wait, what?

That's right; as long as the condition of pregnancy exists, so does the need to terminate some of these pregnancies. Since abortion is the medical procedure used for this indication, there will always be a need for it. But...but, we're not talking about therapeutic terminations here, just elective ones. Are we, really? Because all I see is an article about preventing the need for a perfectly safe and effective medical procedure, period. In any case, even assuming we're only talking about elective terminations, my answer stands. For example, even for the subset of patients who undergo an ETOP as a remedy for contraceptive failure, short of invention of the ideal birth control method--an unrealistic expectation, given the diversity of the user population, there will always be patients who become pregnant and who do not wish to carry the pregnancy to term.

The above question has plagued advocates of choice since abortion was legalized.

Pardon me if I don't take you at your word. Concrete examples in support of this grand assertion, please. What medical organization supporting a woman's choice to make her own medical decisions has ever questioned the need for the availability of the safe and effective medical procedure of abortion?

Some worry that the emphasis on prevention as a solution violates a core belief that good facts make good ethics. Demographers and social scientists are more than skeptical of claims by the group Democrats for Life that we can reduce abortions by 95 percent in 10 years if we modestly increase economic support for women who face unintended pregnancies. The critics note that the level of increased support suggested by this interest group compares unfavorably with the level of support currently afforded to women in European countries -- and the rate of abortions in those countries, while lower than that in the U.S., comes nowhere near the 95/10 goal that DFL espouses.

Frances Kissling, you inscrutable person; what does the first sentence even mean? In any case, since I am not familiar with the research carried out by the Democrats for Life, I would have to look at the study before commenting on its validity. With that proviso, let me just say that, if accurately reported, the group's claim sounds off to me, and here's why.

All the research I've seen on why women have abortions finds that the decision is multifactorial, and there's nothing to indicate that increased economic support would have an impact on some of the most common reasons for having an abortion. For example, in a 2004 study (.pdf) [o]f the 1,160 women who gave at least one reason, 89% gave at least two and 72% gave at least three; the median number of reasons given was four, and some women gave as many as eight reasons out of a possible 13.... Looking just at the three most frequently mentioned reasons for having an abortion, in 44% of cases [Not ready for a(nother) child/timing is wrong (25%); Have completed my childbearing/have other people depending on me/children are grown (19%)] there's no evidence that increasing economic support would have an effect. (It's possible that more funds for more effective contraception, or improved access would have an impact on these groups, but that's just speculation at this point.) By contrast, for the 23% of respondents who mentioned Can't afford a baby now as a reason for their decision, increased economic support might be effective in reducing the abortion rate.

Bottom line: I don't know about "some", but what worries me is uninformed discussion about doing away with a safe and effective medical procedure. I'm also not too keen on proposals to reduce the abortion rate that don't show any familiarity with why women terminate pregnancies.

This takes us back to the very first sentence of this essay. Is abortion a morally neutral act? Is it, as some have said, an unambiguous moral good? This is where we go limp and get tongue-tied. If abortion is such a good thing -- if it results in women coming to terms with their moral autonomy, making good choices for their lives, and acting in the interests of society and their existing and future children -- then why, people ask us, do we want to reduce the need for it? Simply put, the movement as a whole and most of our leaders find it difficult to acknowledge publicly that we have spent our lives, our passion, fighting for something that both is central to human freedom and autonomy, and ends a form of human life.

Abortion is the appropriate medical procedure for terminating a pregnancy. As such--being able to offer our patients a safe, effective treatment--abortion is "good". While I managed to write the preceding without going limp, I can definitely see how reading such unsubstantiated pronouncements like abortion results in women coming to terms with their moral autonomy might cause one to get all tongue-tied. Incredulity tends to have that effect on people.

Now, while I'm not too clear on what coming to terms with their moral autonomy means in this context (coming to terms with the fact that they're being permitted to make their own medical decisions? That they and their internal organs are not one and the same? What?), let me just point out that research indicates something different. Because women have already came to terms with the fact that they are autonomous people, capable of making their own medical, and yes, even, (gasp!) moral, decisions, they think they should be the ones making abortion-related decisions.

And, just to be clear. The result of an abortion is pregnancy termination. The ability of women to make their own medical decisions results in making good choices for their lives, and acting in the interests of society and their existing and future children.... [May I just mention how uncomfortable I am with using "the interests of society" as a criterion to evaluate a medical procedure's outcome.] Not only that, but this ability to make [or, in terms Frances Kissling might understand, be permitted by the State to make] their own medical decisions is what's central to human freedom and autonomy. Nothing more, nothing less.

Last, but not least, if abortion is such a good thing...then why...do we want to reduce the need for it? In a nutshell, because, in select instances, lower risk alternatives are available.

We say we are in favor of legal abortion because it protects women’s lives. We do not mean just their physical lives; we mean their capacity to live full, free and happy lives.

Um, no. We (and by that I mean me) are in favor of allowing female patients to make their own medical decisions not because it protects their lives but because, just like for male patients, there's no evidence that they're incapable of making their own decisions. And while we're on the subject, I have a question of my own. What is it with people like Frances Kissling and their insistence that, when it comes to female patients, danger to life and/or limb is a prerequisite for obtaining proper medical care?

Why do we insist that because the fetus is not a person in any theological, scientific, legal or sociological sense, it does not deserve our consideration? Do not people want to know if those of us who advocate a moral right to choose an abortion also approach all aspects of life with wonder and awe? Can we totally separate our attitude toward the justifiable taking of non-personal life in abortion from the other principles of protecting life that have become crucial to our survival as civilized human beings?

First of all, where is the evidence that women deciding to undergo an abortion make this medical decision without proper consideration?

Second, no, "people" don't want to know because, unlike you, "people" realize that, even if only female patients are involved, medical decisions are [still] not communal decisions. Not to mention the fact that the issue of whether women should be permitted to make their own decisions stands on its own merits, irrespective of the degree of wonder and awe exhibited by assorted advocates of this position.

Third, pardon me for a moment while I try to gather bits of my gray matter off the furniture. Please, somebody take pity on me and define non-personal life. The best I could come up with, in this context, is vascularized (as opposed to necrotic) tissue in vivo. In which case, I say not only should we not try to separate the justifiable taking of non-personal life from the other principles, we must insist it become a core principle. 'Cause what's civilized survival without tissue biopsy or appendectomy.

Although it would be unjust to place on women's reproductive decisions the moral burden of upholding absolutely a presumption in favor of life, it is important that we express our belief that the ability to create and nurture and bring into the world new people should be exercised carefully, consciously, responsibly and with awe for our capacity to create life. That is one reason why we must commit ourselves to working to make abortion unnecessary, and be willing to use those words. We must not flinch when Hillary Clinton says abortion should be "safe, legal and rare." We must applaud pro-choice members of Congress like Rosa DeLauro, who says: "We must create an environment that encourages pregnancies that can be carried to term."

Let's take this one from the top. Although it would be unjust to place on women's reproductive decisions the moral burden of upholding absolutely a presumption in favor of life.... Who says life is just? I say let's place on women's reproductive decisions the moral burden of upholding absolutely a presumption in favor of life. Their life, that is.

...it is important that we express our belief that the ability to create and nurture and bring into the world new people should be exercised carefully, consciously, responsibly and with awe for our capacity to create life. That is one reason why we must commit ourselves to working to make abortion unnecessary, and be willing to use those words.

Not that I'm not as self-centered as the next person, but, in the context of a stranger making a medical decision, I fail to see why it's important that we express our personal beliefs. There's ample opportunity to, if we wish, trumpet our beliefs when we're faced with making our own medical decisions. More to the point, where's the evidence that, as a rule, women AND men (you know, those with the capacity to create life) don't exercise that ability carefully, consciously, responsibly?

Finally, our capacity to create life is not a good enough reason to lose touch with reality. Just like with any other medical procedure, there will always be instances (incomplete spontaneous abortions, congenital malformations, rapes, contraceptive failures, personal circumstances, etc.) when an abortion is necessary. [On a personal note, I must say that I find the presumption that we must do away with a safe and effective medical procedure, just because some people believe it to be icky, quite odd.]

We must not flinch when Hillary Clinton says abortion should be "safe, legal and rare." We must applaud pro-choice members of Congress like Rosa DeLauro, who says: "We must create an environment that encourages pregnancies that can be carried to term."

When a politician speaks, I say we flinch on principle. My bias aside, why must we not flinch when faced with political rhetoric and slogans? And before we dissolve into a clapping frenzy, we must ask Rosa DeLauro a few questions. Like, what evidence does she have that her proposal is more effective then creating an environment that encourages women to be active participants in their healthcare, and to make their own medical decisions? Or, in view of some of the most frequent reasons given for having an abortion--Not ready for a(nother) child/timing is wrong; Have completed my childbearing/have other people depending on me/children are grown--how exactly would we go about creating an environment conducive to carrying pregnancies to term? By separating the women form their current family, giving them a new identity, and placing them in some sort of carrying-a-pregnancy-to-term protection program, in hopes of influencing the timing. Or maybe by removing their existing children, or administering a lobotomy, in the hopes the women will no longer remember they've already completed their childbearing? Since we're making pronouncements with far-reaching implications for the health and the lives of women and their families, let's be be specific, shall we?

Such statements are not made in a vacuum; they are not the idiosyncratic thoughts of Catholics who have some creepy obsession with fetuses. They are part of thoughtful attempts to balance respect for a woman's right to make the choice about when to bring a new child into the world with a deep presumption that life, even the life of non-persons, is worthy of respect. And they should be based on our values, on the desire not to better "message" abortion rights, but to respect the moral sensibilities of American women.

We have been on the defensive so long that we are like lionesses ready to rip out the throat of anyone who attacks our cubs -- and women are our cubs!

...

The reality is that we could use a lot of government involvement in supporting women's moral agency.

And there you have it ladies and gentlemen; the display, at its most majestic that, in the end, it's not about a medical procedure (or, for that matter, our love of plant life, or ecology) but rather about the fundamental assumption of people like Frances Kissling that female patients are infantile boobs incapable of thoughtfulness, whose life is on par with the life of non-persons (aka vascularized tissue), and whose values, decisions and moral sensibilities must be supervised and sanctioned at all times.

Oh, and by the way Frances Kissling, women aren't your, my, or anyone's awkward and inexperienced youths, nor do they need the government (of all the incompetent, corrupt, despicable organizations in existence, she had to pick this one; the indignity!) to prop up their moral agency.

*Williams 21ed., p1518