Source: http://advocatesforpregnantwomen.org/main/publications/articles_and_reports/testimony_to_the_south_dakota_task_force_to_study_abortion.php
Timestamp: 2019-04-18 18:26:09+00:00

Document:
Madame Chairwoman and Members of the Task Force: Thank you for this opportunity to present to you today. My name is Lynn Paltrow. I am an attorney and Executive Director of National Advocates for Pregnant Women, an organization devoted to protecting the interests of pregnant and parenting women and their families. In addition to litigation and policy analysis, I am author and co-author of numerous commentaries and articles including ones published in medical journals such as the American Journal of Obstetrics and Gynecology and the Journal of the American Medical Association 2. I am also a frequent lecturer to medical and public health organizations and to health care providers 3. In addition, I have served on both state and federal panels concerning pregnant and parenting women 4.Many of the cases that I have worked on involve women who have wanted to continue their pregnancies to term and many of these women oppose abortion.
I want to begin by being clear about the women who are the subjects of this Task Force's inquiries. More than half of all women having abortions already are mothers 6, raising one or more children 7. A majority of those having abortions that are not yet raising children, will someday become mothers and spend much of their lives raising and caring for their children and other loved ones. As a result, the questions addressed by this Task Force concern mothers and pregnant women. These are the women that I will be talking about today.
As an attorney, I will be focusing on legal questions especially on the meaning of the term "voluntary." I will also address whether pregnancy should be viewed as some kind of contractual relationship between two wholly independent parties - pregnant woman and fetus. In order to explore these questions I will provide case examples that demonstrate what happens when pregnant women and fetuses are treated as separate and competing legal entities as well as cases where women's reproductive and health decisions have unquestionably not been voluntary.
I begin with the case of Angela Carder: Angela Carder at 27 years old and 25 weeks pregnant became critically ill. She, her husband, and her parents as well as her attending physicians all agreed on treatment designed to keep her alive for as long as possible. The hospital, however, called an emergency hearing to determine the rights of the fetus. A lawyer appointed for the fetus used the anti-abortion argument that fetuses are separate legal persons with independent rights. This lawyer argued that the fetus had a right to life and that what Angela Carder, her husband, and her family wanted did not matter. Despite testimony that a cesarean section could kill Ms. Carder, the court ordered the surgery, finding that the fetus's rights were controlling. The surgery was performed over her explicit objections and resulted in the death of both Angela and her fetus. The fetus, or as in Angela's parents words - their "unborn grandchild" - died within two hours and Ms. Carder died two days later with the c-section listed as a contributing factor 8.
According to the Webster's Third New International Dictionary at 2564 (1981) Voluntary means: "1(a): proceeding from the will: produced in or by an act of choice, (b): performed made, or given of one's own free will, (c): ready, willing, (d): done by design or intention: not accidental: intentional, intended." Clearly the surgery Ms. Carder was forced to have in the name of fetal rights - that ended both her pregnancy and her life - were not voluntary.
The forced surgery that Ms. Madyun endured in the name of fetal rights was not voluntary. In Illinois, another hospital also using anti-abortion arguments claiming the existence of separate legal rights for fetuses, obtained a court order permitting it to force a pregnant woman to undergo a blood transfusion. Doctors "yelled at and forcibly restrained, overpowered and sedated" the woman, in order to carry out the order. 10This blood transfusion was not voluntary.
There are other very clear examples of what "involuntary" means. Over the course of American history, for example, thousands of white American women, 15 Native American, 16 Latina, and African American women were sterilized against their wills, without consent, or under threat. For example, in 1975 ten Chicana women sued Los Angeles County hospital and state officials for incidents of forced and coerced sterilization. One of the women had refused to giver her consent to a sterilization. She was punched in the stomach by a doctor and then sterilized.17This woman's reproductive health experience was unquestionably involuntary.
In the Relf case, two African-American teenagers in Alabama were sterilized without their consent or knowledge. A federal district court found that there was "uncontroverted evidence in the record that minors and other incompetents have been sterilized with federal funds and that an indefinite number of poor people have been improperly coerced into accepting a sterilization operation under the threat that various federally supported welfare benefits would be withdrawn unless they submitted to irreversible sterilization." 18 These reproductive health outcomes were unquestionably involuntary.
These examples of forced, and involuntary treatment of women provide an important contrast to the experience women have of abortion in America today.
Each year approximately one million women in America have abortions. 20 There is no legal, medical, or scientific evidence that these women who have had abortions have done so involuntarily. Indeed, in today's legal and political climate we would have to conclude that the abortion decision is "super voluntary" "ultra voluntary" or "voluntary plus."
The fact that approximately one million women each year have abortions in spite of these requirements, in spite of increasing social and political pressure against abortion, and sometimes in spite of picketers, protesters, and stalkers calling them murderers, 23 should reassure this Task Force that the abortion decision is more voluntary, conscientious, and determined than many health and family related decisions in America today.
I have not been able to find any cases that found that reproductive health providers have forced or coerced abortions. In instances where there have been concerns that family or teachers have attempted to coerce an abortion, the decision in Roe v. Wade has provided pregnant woman with protections. For example, in Arnold v. Bd. of Educ. of Escambia County Ala., 880 F.2d 305, 311 (11th Cir. 1989) parents claimed that a school guidance counselor, vice-principal, and school board coerced a student into having an abortion. The court allowed a civil rights suit against the school officials to go forward. Citing none other than Roe v. Wade, the court explained that our constitutional law ensures that "the individual must be free to decide to carry a child to term." Similarly, in Planned Parenthood v. Casey, the US Supreme court noted that its decision in Roe v. Wade, 410 U.S. 113 (1973), "had been sensibly relied upon to counter" attempts to interfere with a woman's decision to become pregnant or to carry to term. Casey, 505 U.S. 833, 859 (1992).
Lacking case law examples, or peer reviewed, evidence-based research establishing that women's abortion decisions are not voluntary or informed, the analysis called for today relies on implication; the suggestion that the pregnant women and mothers of America are being tricked or manipulated. Far from reflecting involuntary, coerced or misinformed decisions, however, the real experiences of women who are the subject of today's hearings make clear that their decisions are based on profound ethical, religious, and family considerations.
For so many pregnant women and mothers the decision to have an abortion is not only voluntary, it is ethically mandated by obligations to self and to others.
The decision to have an abortion is still "voluntary" even when made in constrained circumstances.
The violence so many women in South Dakota and across America experience on a daily basis is another good example of the meaning of "involuntary." A Task Force to examine why men - who disproportionately though not exclusively - commit violence against women would reflect true valuing of mothers, pregnant women and their families and life itself.
The sad truth is that whether pro-or anti choice, the vast majority of women must make reproductive health decisions in a country that has sent a clear message: We do not value the work that you do as mothers and caretakers. America is one of only three industrialized nations in the world that does not require any paid maternity leave. 35 While holding this Task Force hearing about abortion, South Dakota has not to my knowledge explored the possibility of guaranteeing new mothers or fathers any paid parental leave. Similarly pregnant women of all political and cultural stripes are vulnerable to workplace discrimination. Between 10 and 20 million women, including those who work part-time or for small companies, are not protected from discrimination based on pregnancy. 36 Again, while this legislature has considered numerous bills over the years to restrict access to abortion, 37 no legislation to my knowledge has been introduced, much less passed, to prevent these forms of discrimination against pregnant women and mothers who must work in order to feed and house their children.
Rather than yet more restrictions on abortion, South Dakota's legislature should consider how to help women to care for their families and ensure that pregnant women live in a country where they need not worry that their children will survive infancy or go without health care, food, shelter, a good education, and a safe and healthy environment.
The decision to have an abortion is still voluntary even if some women experience sadness or other feelings at some point after the procedure.
Having said this, it is nevertheless crucial to the lives of all pregnant women and mothers that our families and communities acknowledge that women who have abortions, like those who suffer miscarriages, and those who continue to term, and those who give up their children for adoption, 46 may experience a wide range of emotional responses. However, to use those feelings to suggest that the very deliberate, conscientious, and sometimes difficult decision to have an abortion is some how involuntary or misinformed is to express profound disregard and disrespect for the 25 million women who have made that decision.
Rather than deny women's experiences or risk misusing them to justify a political agenda, this Task Force could support Exhale - a national non-judgmental abortion talk-line that offers women as well as friends and family members a place to talk about their feelings. 47(1-866-4-EXHALE). Similarly, this Task Force could, if truly concerned with the lives and well-being of all pregnant women and mothers, endorse full parity for mental health services for everyone who needs them.
It is not possible to treat pregnant women and fetuses as competing legal entities in the context of abortion without undermining the health, wellbeing and safety of all pregnant women and new mothers.
This committee also asked me to consider "the degree to which such abortion constitutes an appropriate legal waiver or termination of the relationship between the woman and the unborn child."
If pregnancy is a "legal" "relationship," with opposing rights and the possibility of state oversight, the implications for the civil rights, health and well-being of pregnant women and their children is in serious question. Does a pregnant woman who cannot overcome her addiction to cigarettes violate this "legal" "relationship," making her an appropriate subject for court ordered treatment, arrest for child endangerment, or child welfare interventions? Does a woman lose her right to informed medical decision when she becomes pregnant? Could the state mandate that all women deliver by c-section because of perceived benefits to the unborn child? Could the state outlaw vaginal births after c-sections?
Similarly, if pregnancy is viewed as a legal relationship between completely separate parties having separate, competing rights, shouldn't every woman who has experienced a miscarriage or stillbirth be questioned about the extent to which she may have contributed to that pregnancy loss and whether those actions or omissions constituted an appropriate legal waiver?
These questions do not represent far-fetched hypothetical possibilities.
Finally, the earlier exampled of forced surgery over the objections of pregnant women, husbands and doctors has been the direct result of giving legitimacy to the idea of legal separation between pregnant women and the fetuses they carry.
This Task Force must recognize that to oppose the recognition of fetal personhood as a matter of law is not to deny the value and importance of potential life as matter of religious belief, emotional conviction, or personal experience. Rather, by rejecting such a new legal construct, the Task Force can improve both maternal and fetal health and ensure that no family ever had to endure the losses that Angela Carder's family suffered at the hands of the state, in the name of fetal rights.
By focusing exclusively on abortion, the committee implies that the provision of health care to women who continue to term is more than adequate and closes its eyes to the many serious problems such women face in accessing fully voluntary and informed care. In fact, many women who are giving birth are not provided with essential information. For example, the World Health Organization considers acceptable levels for cesarean rates as not less than 5% and not more than 15% of all deliveries.61 Yet approximately 28% of all US births are by cesarean delivery, accounting for approximately one million cesareans.62 Some providers and hospitals have even higher rates. Nevertheless, South Dakota does not require health care providers to provide expectant parents with information about their c-section rates and related information, including rates of births using induction and births utilizing episiotomies.63 Such information is necessary in order for families to make informed decisions about which providers they will use for their deliveries.
Moreover, a growing number of pregnant women in America are now giving birth inside jails and prisons, some delivering while shackled to their beds, others left to give birth or miscarry in a prison bathroom.67 A true commitment to all pregnant women and mothers would require investigation of all aspects of reproductive health care in all contexts, not just the care provided to women seeking to end their pregnancies.
Reproductive health care providers in general also often fail to provide women with essential information about the possibility of miscarriage and stillbirths. Even though miscarriages and stillbirths occur in as many as 15-20 percent of all pregnancies, ob/gyns and prenatal care providers rarely inform women of this risk or offer information that would help women prepare for and cope with this very common and very possible loss.68 South Dakota does not mandate such disclosure nor create mechanisms for training health care providers in how to convey this information or provide support through the process. The narrow focus of this Task Force again suggests a lack of concern for all pregnant women.
Earlier testimony also claimed that abortion providers fail to screen women for a history of sexual abuse and violence. Although it is unclear that any peer reviewed research finds any unique failure on the part of abortion providers in this regard, it is clear that raising this concern only on behalf of women seeking to end their pregnancies creates the disturbingly false impression that all other pregnant women and mothers are carefully screened and counseled. In fact numerous studies find that few physicians screen their patients for abuse. 69 A 1990 study published in the Journal of the American Medical Association found that only 10 percent of primary care physicians routinely screen for intimate partner abuse during patient visits.70 Again, I need to ask if this Task Force in fact wishes to ignore the needs of the majority of pregnant women who continue their pregnancies to term each year and potentially make their situation worse by creating the impression that somehow their health care and informational needs are being fully met?
Earlier today, a witness also suggested that the voluntary nature of abortion services should be doubted because some women obtaining abortions do not meet the person who will perform the procedure until a few minutes beforehand. Even if true, there is no research to suggest that this phenomenon in any way jeopardizes women's health or in any way undermines the informed consent process. What this argument does do however, is create another false impression; that other medical patients are getting better care and more individual attention from their physicians than the group selected for scrutiny by this panel - pregnant women seeking to end their pregnancies.
In fact as the March of Dimes recently noted: "An extensive literature documents that many uninsured Americans do not receive necessary or appropriate medical care."76 Moreover, low-income pregnant women receiving publicly funded care often "go to overcrowded hospitals staffed by interns and residents who are overworked and insufficiently trained."77 Again it is necessary to ask why, given the pressing problems so many American's face in obtaining adequate prenatal and delivery services as well as a full range of other health care , the focus is on one procedure - abortion - that has been proven time and again to be safe, effective, and voluntary?
Lacking scientific or medical evidence of its danger or harm, those opposed to abortion as a matter of religious or personal convictions must resort to the strategy of creating doubt. Posing questions such as "Are abortion decisions really voluntary?" and suggesting that not enough research has been done to demonstrate the safety and efficacy of abortion services is a strategy with fascinating parallels to the effort to undermine environmental protections. There, in the face of overwhelming evidence of human contribution to global warming, opponents of environmental protection and regulation create doubt about the extensive science establishing the relationship between human behavior and environmental hazards.
Suggesting that the 25 million women who have chosen to have abortions since 1973 somehow were acting under circumstances of coercion, force, or deception, serves the political purpose of creating doubt about the women who have made the abortion decision and about the safety, efficacy, and value of legal abortion itself. Perhaps even more disturbing is the extent to which such questions create doubt about pregnant women and mothers as moral agents and valued members of our society.
The questions that this Task Force is considering do not focus on pregnant women and mothers as life and caregivers - but rather only as people who "terminate" or abandon their "unborn children." This focus distracts attention from the profound debt America owes to its pregnant women and mothers. American women - many of whom at some point in their lives have had or will have abortions - "do 80 percent of the child care and two-thirds of the housework."81 They do this work without any form of formal compensation, without any guaranteed pensions, and without any form of insurance or healthcare should they need it. Economists suggest that if Americans had to pay for the volunteer and unpaid labor that America's pregnant women and mothers do, we would go bankrupt.
We claim to be a culture of life - but that has little meaning when the primary way we value the women who give that life is to portray them as incompetent decision makers and limit their access to abortion services. If we truly love and respect our mothers we will address the range of health and economic issues they really do harm them and their children. Suggesting that they cannot make decisions or that they need to be supervised by courts or psychiatrists says yet again to America's pregnant women and mothers We do not value you or the work you do. South Dakota has the opportunity to send a different message: We take mothers and parenthood seriously, and our next hearings will be about how to ensure that you have the health insurance, economic security, and access to educational resources that you and your family need.
The author wishes to acknowledge and thank Professor Jeanne Flavin, Sarah K. Schindler-Williams, Katy Quissel, and Wen-Hua Yang for their assistance in preparing this testimony.
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John Leland, Under Din of Abortion Debate, An Experience Shared Quietly, N.Y. TIMES (Sept. 18, 2005 at A1) (citing a report of the Centers for Disease Control available http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5309a1.htm#tab12).
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style="font-style: italic;">Foreclosing the Use of Force: A.C. Reversed.
THE HASTINGS CENTER REPORT 27, July 1, 1990.
style="font-style: italic;">Whose Body Is It, Anyway, THE WASHINGTON POST (“On July 26, at 3:32 a.m., Ayesha Madyun delivered a 61/2-pound baby boy who was born with excellent lungs and no sign of infection.”).
In re Fetus Brown, 689 N.E.2d 397, 400 (Ill. App. Ct. 1997) (overturning a court-ordered blood transfusion of a pregnant woman). See also In re Baby Boy Doe, 632 N.E.2d 326 (Ill. App. Ct. 1994) (holding that courts may not balance whatever rights a fetus may have against the rights of a competent woman, whose choice to refuse medical treatment as invasive as a cesarean section must be honored even if the choice may be harmful to the fetus).
Id. See also, WVHCS-Hospital, Inc. and Baby Doe, v. Jane Doe and John Doe, Motion for Special Injunction Order and Appointment of Guardian at 4. (Emphasis added).
of Lynchburg, BALT. SUN, May 6, 2001, at 7F (describing the rise of eugenic sterilization laws in the United States including interviews with some people who had been forcibly sterilized).
In 1976 the U.S. General Accounting Office revealed that the federally funded Indian Health Service had sterilized 3,000 Native American women in a four-year period using consent forms "not in compliance ... with regulations." See also, WARD CHURCHILL, A LITTLE MATTER OF GENOCIDE: HOLOCAUST AND DENIAL IN THE AMERICAS 1492 TO THE PRESENT 249-50 (1997) (arguing as much as forty-two percent were sterilized); PAULA GUNN ALLEN, OFF THE RESERVATION: REFLECTIONS ON BOUNDARY-BUSTING, BORDER-CROSSING, LOOSE CANONS 38 (1998) (arguing more than twenty-five percent were sterilized).
NEW AMERICAN MOVEMENT (June 1976). Angela Hooton reports that Black and Latina women have been required to undergo sterilization as a condition of their probation or receipt of welfare benefits. In one case, a 21 year-old defendant was indicted for being present in the same room as her boyfriend while he smoked marijuana but was allowed probation conditional on her acceptance of sterilization.
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