Kinsley in Slate, with some good observations, and a fog machine:
The artifice can get quite elaborate. Sen. Arlen Specter, chairman of the Judiciary Committee, makes a half-serious distinction among precedents, super-precedents, and super-duper precedents. Others emphasize that social policies can start with a Supreme Court ruling and develop into deeply rooted national values. That happened with Roe and abortion, they would say, while the opposite happened with Bowers and laws against homosexuality. Of course if a policy has really become a deeply rooted national value, then the once-controversial Supreme Court ruling is superfluous, because democracy will protect such a value. The fear that motivates Roe panic is that the rights at stake are not deeply rooted. Or not deeply rooted enough.
While Roe defenders play this double game, ostensible Roe opponents, especially those in the White House, may be playing a triple game. Their public position is A) Roe is a terrible decision, responsible for a vast slaughter of innocents; B) legal abortion is deeply immoral; C) we ignore all this in choosing Supreme Court justices, and you (Roe defenders) should, too. It doesn't make sense, and it's not believable. The natural assumption is that Bush is trying to con abortion-rights supporters. Only an idiot would squander the opportunity to rid the nation of Roe because of some fatuous nonsense about picking judges without finding out the one thing you most urgently want to know.
But Machiavellians of my acquaintance believe that it is the anti-abortion folks who are getting conned. The last thing in the world that Republican strategists want is the repeal of Roe. If abortion becomes a legislative issue again, all those pro-choice women and men who have been voting Republican because abortion was safe would have to reconsider, and many would bolt. Meanwhile, the reversal of Roe would energize the left the way Roe itself energized the right. Who needs that?
Abortion is the most important issue in American politics. It shouldn't be. Others have as big an impact on the lives of individuals and a far bigger cumulative effect on society. No other nation obsesses about abortion the way we do. But many Americans believe that legalized abortion is government-sanctioned murder or something close to it. And many others (including me) believe that forcing a woman to go through an unwanted pregnancy and childbirth is the most extreme unjustified government intrusion on personal freedom short of sanctioning murder.
And then, in The New Republic, a piece on multiple abortions.
I never can grasp the reason why, if one abortion is morally neutral and no one's business, having another one is any different. "Troubling." Be consistent, people.
Yet the reluctance of liberals and pro-choice advocates to shine a spotlight on the troubling repeat-abortion phenomenon has obscured a growing public health issue. 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. Liberals have always sought to aid the neediest, but their fear of undermining abortion rights has paralyzed them when it comes to helping women at risk of repeat abortion. The sad fact is that, three decades after legalization, abortion is no longer mainly a tool women use to shape their own destinies, but rather a symptom of larger social problems that ought to be addressed by policymakers. Realizing this may just mean accepting that there's some credibility to conservative views on abortion.
The U.S. abortion rate has declined since its peak in 1980, so that, today, only 2 percent of women between the ages of 15 and 44, or roughly 1.3 million women, have abortions each year. This is good news for liberals--especially the "safe, legal, and rare" crowd that is eager to show that the abortion rate is declining--but these numbers also conceal a meaningful demographic shift. In 1973, the majority of American women who obtained abortions were white and childless. Since then, tremendous advances in birth control options--coupled with an upsurge in condom use in response to the aids epidemic, approval of the morning-after pill, and anti-teen pregnancy programs--have contributed to an overall decline in abortions, especially among the very young women most likely to have sought abortions in the past. Defying the pregnant-teen stereotype, only 19 percent of women getting abortions in 2000 were adolescents, according to Guttmacher, down from 33 percent in 1972.
But the trends aren't quite so propitious for other groups of women. While the overall U.S. abortion rate declined between 1994 and 2000 for nearly all population groups, it continued to rise among low-income women and women on Medicaid. And a growing proportion of women getting abortions are members of a minority group. During that same time period, the abortion rate fell 20 percent among white women but only 10 percent among Latinas and 8 percent among black women. Although they account for roughly 30 percent of the population, minorities represented fully 59 percent of women getting abortions in 2000. In contrast to the mostly childless women getting abortions in the '70s, 60 percent of women getting abortions today are already mothers. If the goal is to decrease abortion rates, then the social and medical changes driving today's lower overall abortion rate are leaving these women behind.
The whole point of defending abortion rights is so women can have control over their own destinies. The data, however, clearly show that a lot of women getting abortions are doing so precisely because they don't have control over their destinies, and perhaps never did. What few studies there have been of women who have repeat abortions paint a particularly disturbing picture. Rather than being the free choice of a woman controlling her own fate, repeat abortion operates as a kind of surrogate marker in women's lives for many other things that have gone awry.
A Canadian study of 1,145 women found that those getting repeat abortions in 1998-1999 were much more likely to have a history of sexual or physical abuse. "Presentation for abortion," the researchers concluded, "may be an important indication to screen for a current or past history of relationship violence or sexual abuse." Repeat patients were less likely to report they had "lots of friends" and "lots of plans for the future," and they reported significant conflict with their current partners.
Given these realities, it is high time that pro-choice advocates and their political defenders begin to treat abortion as a public health issue, rather than just a philosophical or political problem. Pro-choice advocates argue that women need the fail-safe of legal abortion in order to be free. Pro-life groups argue that the recriminalization of abortion will force women and men to become more sexually conservative and socially traditional, to their mutual benefit. But what women who abort appear to really need is the kind of help and social support that neither side has been willing to give them.
he great irony is that the reluctance to address repeat abortions has caused U.S. private sector abortion services to lag behind those offered elsewhere in the world. Since 1993, the leading international family planning and women's health groups have been trying to address the repeat abortion problem under the auspices of the Postabortion Care Consortium. The Consortium was motivated by concerns about unsafe abortions, among other things. The U.S. Agency for International Development works closely with the Consortium and has funded programs aimed, in part, to reduce repeat abortions in Turkey, Egypt, Russia, and several African and Latin American nations. The World Health Organization has advocated post-abortion care and counseling since 1991, and support for it was written into the 1995 U.N. Fourth World Conference on Women Platform for Action.
Though U.S. abortion services are much safer from a medical standpoint, it's time to consider whether secular post-abortion care and counseling services ought to be made available domestically as a routine part of women's health care as well. Such services could help women who abort gain control of their lives after abortion, get linked up with an appropriate form of birth control, and--most importantly--avoid descending into crisis once again.
Advocates brave enough to take on this subject will find broad support for it in the medical literature. A 1997 Guttmacher study recommended that "more intensive contraceptive counseling and services should be provided to first-time abortion patients who are young" or otherwise at high risk of repeat abortion. The Canadians who recommended screening for sexual or physical abuse posited that "such screening could result in offers for referral and counseling that might prove helpful to the woman ... and could potentially help avert a future abortion."
There are some post-abortion services available already in the United States, though the efforts are mostly piecemeal. Atlanta's Feminist Women's Health Center, one of the oldest abortion providers in the country, offers a shot of the long-acting hormonal contraceptive Depo-Provera and post-abortion counseling to all women who obtain procedures there. Planned Parenthood also has begun to offer post-abortion counseling services at some of its clinics, and it has long made sure that all women who leave their standard post-abortion follow-up visit are provided with a form of birth control.
But such efforts clearly have not been enough, and there has been little research into how to most effectively prevent repeat abortions. Indeed, it could reasonably be argued that providing poor women with job-training and life-counseling after abortion might do as much to reduce repeat abortions as providing birth control. Reaching out to men with post-abortion counseling and contraceptive information might also make a difference. Partly because they are older, women who get repeat abortions are less likely to be single, and one study at a Baltimore hospital found that one-third of women were accompanied to their abortion by the man who had impregnated them. If such men are "not included in counseling in any way, it constitutes a missed opportunity to reduce repeat abortions," Stan Becker, a professor at the Johns Hopkins Bloomberg School of Public Health and a study author, said when it was released in 2004. More research into what kinds of contraception are best for post-abortion women would also be beneficial. The high rate of daily birth control pill use reported among women seeking repeat abortions, for example, suggests that this method may be less effective for them than the weekly patch or Depo-Provera.
Polarization on abortion has kept those who defend a woman's right to choose silent on this issue. But pro-choice liberals must protect women from the poverty and abuse that often lead to abortion as fiercely as they protect the procedure itself. The growth of groups like Exhale shows that women who have had abortions need to be able to talk honestly about their experiences, including repeat abortion. Three decades after Roe v. Wade, liberals should still follow women's leads.
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