Repeat abortions

Kevin Drum points to Garance Franke-Ruta's article on repeat abortions. (TNR, free registration)

Franke-Ruta suggests that pro-choice liberals are reluctant to publicly support post-abortion counseling.
Her primary evidence for this claim is that a NARAL spokesman declined to comment on strategies for reducing repeat abortions.

Franke-Ruta is attacking a straw man. She says that society needs to confront abortion as a public health problem as well as a philosophical and political issue. She is right, of course. However, NARAL's business is political advocacy, not public health. We don't ask NARAL for any other form of birth control advice. So, why do we expect the organization to take an official stance on this issue? Obviously, if someone proposes a law mandating abortion-related counseling (pre- or post-), NARAL should weigh in. Otherwise, questions about how to prevent unwanted pregnancy are more appropriate for Planned Parenthood or the American College of Obstetricians and Gynecologists.

Comments

[rob helpy-chalk]

Some replies from skimming the article.

Are we surpised that there weren't many repeat abortions in 1973? Prior to then, abortion was only legal in a few states.

18 percent of abortions were performed on women seeking at least their third pregnancy termination. In contrast, studies have shown that rape and incest victims, the most politically sympathetic and high-profile group of abortion-seekers, account for about 1 percent of abortions.

...

Studies suggest that women having repeat abortions as compared with those having first-time abortions are more likely to be minorities, poor, and victims of sexual abuse--in short, among society's most vulnerable.

First she contrasts women who have repeat abortions with victims of abuse, then she points out that they are more likely to be victims of abuse.

The real problem with her argument, I think, is that she wants to treat repeat abortion as a problem in itself, when really it is mostly a symptom of deeper problems. Moreover, the deeper problems--mostly a lack of real sexual autonomy--are precisely the ones feminist and reproductive rights groups are trying to address.

[John]

An interesting article on the subject is up on Nerve, definitely more sophisticated than TNR.
http://www.nerve.com/dispatches/baumgardner/secondabortion/

[Horatio]

Usually criticisms of organizations stem from the fact that there is too much "mission creep," not too little. You're right. Regardless about one feels on the subject, it's ludicrous to expect NARAL to fundamentally overhaul their organization. By way of comparison, why not expect Club For Growth to do credit counseling?

[Squashed Lemon]

There should be a movement to drive down morning after pill cost and birth control pills. Obviously it's people who can't afford it are needing it the most. $30/a month? should it be $30/a year?

hmmm... wonder what is the cost structure of birth control pills.

[John Emerson]

Couldn't it be argued that repeat abortions are not a problem of any kind?

Or maybe just a normal-range personal problem, like obesity or overuse of credit cards, and not something to gighlight as a moral or a political issue?

It seems that there's a lingering guilt about abortion behind this -- "Abortion is not morally wrong, IF......"

[blah]

What does it mean "to confront abortion as a public health problem"? Does it meant that because their are health risks associated with abortion, we should make them safe, legal and rare? Who exactly is failing to confront abortion as a public health problem?

I am too lazy to read the article.

[Kevin Drum]

It's true that NARAL is primarily in the business of advocating for reproductive rights, but you'll also find this in their mission statement:

"NARAL Pro-Choice America works to reduce the need for abortions."

Garance is suggesting that post-abortion counseling would reduce the need for future abortions, which seems to be right up their alley. The form of this counseling would certainly include advice on things like access to contraceptives, which is also right up their alley.

I don't expect this to be their main focus or anything, but it really does seem to be something they should at least be willing to address.

As for the broader claim that pro-choice liberals are uneasy about the whole subject, I too found that surprising. I don't know for sure that it's true, but Garance does provide some anecdotal evidence beyond just NARAL's refusal to comment. I'd be interested in hearing more, though.

[Matt]

What's wrong w/ repeat abortions? Abortions are expensive compared to being on birth control, at least for most people. Like any medical procedure there is the potential for complications. Right or wrong (usually wrong, to my mind) people tend to feel more morally conflicted over abortions than birth control, and this might be worse for a second or 3rd abortion. For _some_ percentage, they are an indication of not taking enough care of one's self. Obnoxious jerks will write moralistic articles about you and wring their hands. This is all to say that there's nothing wrong w/ them _as such_, though they may be indicative of other problems, and even if they get the undies of self-rightous moralists in a twist. (If abortion isn't wrong, then two of them are not wrong, either, I'd guess.)

[1984 Was Not a Shopping List]

>NARAL's refusal to comment.

I wouldn't be surprised to find NARAL being aware of public relations concerns, since abortion is such a charged issue. I suppose one of the problems about abortion is that it's (or it ought to be) such a private affair, varying with each individual's circumstances, but that so many people weigh in on the matter, seeking to have a blanket solution, without taking these individual cases' uniqueness into account.

If you're concerned about this, you'll be interested to note that the current Vanity Fair mentions that George W had assured an ultra-right group that he courts that Harriet Miers was sure to overturn Roe vs. Wade. Justices can and do surprise the presidents that nominate them, and some of our law students may want to provide their better-read opinions, but I would expect that 1) each of W's nominees will come with that same promise, and 2) W having packed the court, a convenient and well-funded challenge to Roe v. Wade may well appear.

[John Emerson]

As far as I know, having five abortions is no worse a health risk than having five births -- perhaps less.

[gordo]

Maybe I'm misreading the article, but it seemed like Franke-Ruta was most concerned by the fact that abortion is not a completely free choice for a significant segment of women.

What surprised me was that Franke-Ruta completely ignores economic considerations. She points out that non-white women and victims of abuse are much more likely to seek abortions, but her remedies focus entirely on counseling and birth control.

These women are, as a group, less likely than most to be capable of supporting several children. Add in the fact, mentioned by Franke-Ruta, that many are already mothers when they seek abortions. Could it be that this group is more likely to seek abortions because they are less likely to be financially able to support several children?

The woman who cuts my hair recently had an unwanted pregnancy. She's choosing to have her third child. I think that if she weren't living in a two income household, it would be much harder for her to make this choice.

My point is that if we're really pro-choice, we need to look beyond legal abortion and birth control. As the fundies never tire of reminding us, no method of birth control is foolproof. If women are going to be truly free to choose, we have to make a greater effort to support programs that allow women to support their children, and stop allowing the Republicans to force abortions on women by cutting welfare, medicare, and food stamps.

[Matt Taylor]

Garance is obsessed with proving she is "centrist" by knocking down straw men.

[rob helpychalk]

The risks from five abortions are less than the risk of five live births, but is that the right comparison? If someone chooses to have five children they are taking a risk to gain a benefit they want. Someone who has five abortions has gotten herself into the same bind five times. This certainly seems like a sign of a deeper problem.

I was acquainted with a woman once who had five abortions. She talked about them compulsively, to literally everyone. She clearly had issues. I know other people, though, who have had repeat abortions who were just unlucky.

Also, most people, regardless of the rhetoric they spout, actually grant the fetus a middling level of moral status. A fetus is more important than a rock, but less important than a person, and becomes more important as it develops. People who do this might fully support a woman’s right to choose, but still think that people who have repeat abortions are doing something wrong.

Provisionally, I would compare a woman like the woman I was acquainted with who had five abortions and some other emotional issues to someone who neglects or mistreats their pets because they can't get their life together.

A lot of people freak out at the fetus/nonhuman animal comparison, and it has real limits, but it is helpful as a first approximation.

[figleaf]

I don't think anyone on our side of the debate is questioning anyone's right to have multiple abortions. I'm certainly not!

I do agree with Garance and almost anyone with a brain that if 50% of abortions are second or subsequent visits then something is wrong elsewhere in the system. (Considering the current political climate this is barkingly obvious but bears repeating over and over.)

Something is wrong in particular because, having escorted friends and strangers to have abortions since before Roe v. Wade and having sat with my partner during an excruciating post-miscarriage D&E committed by an inept and clearly unpracticed pro-life ob/gyn I'm aware by proxy that abortions are usually painful enough not to be a primary choice of birth control. Plus they're expensive, and while they're by no means as risky as pregnancy and delivery they're still far riskier than finding ways not to get pregnant to begin with if at all possible.

So that 50% number bugs me not because abortions are intrinsically bad, immoral, unethical, or wrong (they're not) but because a lot of women are being let down in way too many ways. I'll enumerate three: 1) They aren't receiving adequate education and/or 2) they don't have access to affordable/followable/reliable contraception and/or 3) they aren't receiving adequate social support (informal and institutional) to employ whatever education and contraception they have received. This isn't necessarily surprising in a country that's surpassed only by Iran in terms of barriers to contraception but it's still problematic.

Having volunteered for NARAL back before they repurposed themselves as NARAL/Pro-choice America I'm comfortable with your point that they're an advocacy group and not necessarily a contraception advocacy group. On the other hand I'm also aware that, at least into the 1990s (according to a Washington Monthly article on contraception I took notes on back then) Planned Parenthood contributed to a deadlock situation in Congress (at least the Senate and, I believe, the House) that effectively blocked all new appropriations and legislation linked to contraception. (The article named Planned Parenthood as one of a group of pro-choice advocates who refused to support initiatives that didn't include funding for abortion while a group of anti-choice advocates including The Christian Coalition refused to support initiatives that did. With no support nothing happened for at least ten years. The subsequent Gingrich revolution of 1994 changed the dynamics somewhat but the article predated those changes.) The point being that while NARAL may not have any responsibility for the current state of contraception in America, other progressive, pro-choice groups certainly do.

I ought to add that contraception policy is not irrelevant in this debate. Having bitten the bullet, registered for TNR, and read Garance's article I'd like to point out what seems to me to be the crux of her lead paragraph: "...when, after a condom failure..." Back in 1970 and 1971 when I was an active volunteer for a sex information and referral service that provided birth-control and abortion assistance we were told that the only form of birth control more useless than condoms was the rhythm method. It's boggling that 35 years later people are still relying on the damn things. I appreciate that they're helpful for limiting the spread of infectious disease but I really wonder if several billion dollars spent over the last 20-25 years might not have produced something more reliable with no more side effects *had any major group with serious pro-choice credentials been seriously lobbying for it!*

I can't speak for any other middle-aged men, and I certainly don't presume to speak for any women, but I would like to the number of necessary abortions drop by at least half and preferably by a factor of 10. The current figure, "500,000 abortions performed a year," has a galvanizing ring to it. This certainly hasn't escaped the attention of the troglodytes running their anti-choice scams. Operation Rescue's Randall Terry is on record saying that birth control policies need to be curtailed to keep the number of abortions at an inflammatorily high level. His, in my opinion, very well-founded fear is that if safe, effective, and available contraception was widely accessible annual abortions would fall to a rate most American would find acceptable -- an eventuality that would, in Terry's opinion, be a disaster for conservatives. Thus the failures to address the need to reduce abortions on the demand side -- for whatever historical reasons -- aids and abets those would instead reduce it on the supply side.

Thus that 50% number really leaps out at me as an opportunity rather than an obstacle or scandal (maybe for middle-aged straw men?) or an irrelevancy. No one I'm aware of views abortion as an objective good. Instead it's an objective necessity that needs to remain an inalienable right. If by reducing that necessity through appropriate and accessible we can undercut the conservatives that are trying to destroy our American way of life, and if progressives are dithering about ways to reframe issues to our advantage then we ought to look at this as a way to do it. If 'wingers, framing the social conditions that produce unwanted pregnancies as an abortion issue are able to peel off moderates uneasy about abortion we ought to be able to reframe those conditions as a contraception and contraception availability issue and peel them right back... without in any way compromising on abortion as a fundamental right.

To make a too-long story short I'm not saying that NARAL needs to tackle this issue. I'm not even saying Planned Parenthood should even though their mission does include contraception. Actually I think both those agencies are already filling critical abortion-related needs. I am saying, though, that *somebody* needs to be willing to focus intensely on the issues of contraception, contraception education, and contraception availability. And the issue I see

Incidentally I can think of a whole mess of Democrats who are looking for better ways to distinguish their policies from those of their main political rivals. If I thought they were maxed out managing other pressing issues I'd be more reluctant to add another plank to their platform but actually I think they've got quite a lot of time on their hands since the current administration are having a bit of a train wreck and so I think they could easily do both. But if not them then who? That's the whole problem because I don't know. I don't see anybody in the US who's trying it. (Pro-Familia comes to mind -- they've been pretty effective in other countries -- but they don't seem to have much presence here.)

Rather than take pot-shots at Garance or Kevin Drum or others for their (mis)perceived softness I'd like to see a little more heat put on the bastards that are trying to frame abortion back into alleys and off-shore facilities. There's a big, big difference between Bill Clinton's wimpy and compromised "Let's keep abortion safe, legal, and rare" and my preference which would be to say "Let's make abortion safe, legal, and rarely necessary" and I'd like to hear someone with more brains, more heart, and more influence than I've got out there saying it.

Eek! Sorry about the dissertation.

figleaf

p.s. Contraception policy and abortion-rights are particularly dear issues to sex bloggers but as the URL suggests my site is not at all work safe.

p.p.s. I wasn't aware that Garance Franke-Ruta was a closet right-winger who only tries to pass as a centrist, as one of the commenters suggests. No doubt this will disappoint her colleagues at TAP.

[figleaf]

Oh bother. I've completely bolloxed my editing, such as it is. Oh well, I accept that I'm an incompetent writer but I hope my points aren't totally lost. Apologies.

figleaf

[gordo]

Figleaf--

Perhaps it was unfair of me to address what Franke-Ruta didn't say, rather than what she said. I do agree that we should make a better effort to make information and birth control available. I agree that the timing appears to be right to make a big push on this front. From a tactical point of view, though, it's probably not a good idea to dwell on the number of 2nd and 3rd abortions. As Franke-Ruta points out, there are too many people in our society who stigmatize multiple abortions.

That said, I was a bit disappointed with the non-mention of some obvious economic factors. I know that every article has a limited focus, but choice is the central issue here, not the legality of abortion or availability of contraception. Those are means to an end. We can't really claim to be "pro-choice" if the only viable choice we provide is abortion vs. birth control.

[Squashed Lemon]

How many multiple abortion out there anyway? I smell wingnut hysteria. (onooo collapse of civilization, epidemic, ...)

jeebus, somebody ought to completely deconstruct the entire evangelism movement inside out and be done with it.

How hard can it be? They are just bunch of second rate wackos anyway. Any comparative religion students out there up for social engineering job?

[Gary Sugar]

Drum says, Garance's main policy proposal is that "post-abortion care and counseling services ought to be made available domestically as a routine part of women's health care," and this sure doesn't sound very controversial to me.

This is such nonsense. NARAL has limited resources like everyone else. Who is going to pay for this post-abortion counseling that Franke-Ruta and Drum think NARAL should provide?

[Squashed Lemon]

let's rethink the whole think from ground up.

1. if one would to create a online pro-choice campaign, how would one do it?

2. let's say targetting the wackiest evangelism forum. (just to keep it a simple experiment as case study.)

3. what sort of understanding do we need to have to deliver the message? (dogma interpretation, cultural perception, literary interpretation, rehtorical skill, message delivry, etc.)

answering wingnut publication is getting old, It's like having a barking contest with a dog, instead of addressing the dog owner.

They will keep writiing those crap since they are paid writer.

So let's bring the argument to their side and let see some head explodes.

time for majik to get a wiki.

[Squashed Lemon]

on related news. Well, wingnuts are about to get their way.

http://news.yahoo.com/s/nm/20051130/pl_nm/court_abortion_dc

Top court reviews abortion notice law

The
U.S. Supreme Court takes up its first abortion case in five years and returns to one of its most contentious issues on Wednesday when it considers a state law requiring notification of a parent before a minor can end her pregnancy.

Arguments on the New Hampshire law will be the first abortion case for new Chief Justice John Roberts. It could give some indication whether he supports giving states more power to restrict abortions.

Roberts, who was nominated by
President George W. Bush, has never ruled on an abortion case. At his Senate confirmation hearing, he declined to say how he would vote on future cases.

The case does not involve a challenge to the landmark
Roe v. Wade decision in 1973 that established that women have a constitutional right to abortion.

And it could end up being argued again if the justices are split by a 4-4 vote and cannot get out a decision by the time retiring Justice
Sandra Day O'Connor leaves the court.

[Squashed Lemon]

Atrios is outraged. He is publishing his wanker of the day early. must read.

http://atrios.blogspot.com/2005_11_27_atrios_archive.html#113341177570008699

Wanker of the Day

Yes, it's 20 minutes early but what the hell.

Dalton Conley:

That is her right, of course, and nobody should be able to take that away. But when men and women engage in sexual relations both parties recognize the potential for creating life. If both parties willingly participate then shouldn't both have a say in whether to keep a baby that results?

...

The bottom line is that if we want to make fathers relevant, they need rights, too. If a father is willing to legally commit to raising a child with no help from the mother he should be able to obtain an injunction against the abortion of the fetus he helped create.

Sometimes I wish the level of debate in our elite national publications could exceed, ever so slightly, the level of late night freshman dorm conversations. When he writes "have a say in whether to keep a baby" what he actually means is "decide what a woman does with her uterus." It would be nice if there were some intermediate position, but biology dictates that there just isn't. Either you have the baby or you don't. Someone has the right to make that decision for themselves or they don't. And, of course, he eventually makes that clear. He doesn't mean "have a say." He means "decide."

I suggest all sensible women "decide" to not let their vaginas get within 20 miles of this guy. He thinks he has the right to decide, once he voluntary donates his sperm to you, that you must carry the child to term.

Fucking wanker.

[SL]

on other news. (at least some corporation stand up against wingnuts)

http://americablog.blogspot.com/2005/12/walgreens-puts-4-illinois-pharmacists.html

Walgreen's puts 4 Illinois pharmacists on leave for refusing to fill prescriptions for emergency contraception
by John in DC - 12/01/2005 10:10:00 AM

Good. This is turning into a growing problem, and it's absurd for these pharmacists to talk about their religious and moral beliefs. I go to the pharmacy for medicine, not spiritual advice. If you're opposed to the death penalty, don't apply for a job as an excecutioner. If you're allergic to animals, don't become a vet. And if you hate kids, don't become a pediatrician. It's absurd that these people have decided to be pharmacists, then turn around and saying being a pharmacist is against their religion. Great, it's not against mine. Give me my damn prescription.

[gordo]

Walgreen's was also one of the few chains that matched contributions for Katrina relief. I'm certainly willing to stop there on my way home from the supermarket to pick up soap, shampoo, razors, etc.

[1984 Was Not a Shopping List]

>answering wingnut publication is getting old, It's like having a barking contest with a dog, instead of addressing the dog owner.

Loved that.

>They will keep writiing those crap since they are paid writer.