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Reproductive-rights activists gathered yesterday to blow out 36 candles on Roe v. Wade's birthday cake, feeling particularly giddy over the new president's staunch support of abortion rights. Indeed, Obama yesterday affirmed his belief in a woman's "right to choose," saying the government shouldn't intrude on "our most private family matters." And today he plans to overturn the global gag rule, which restricted U.S. funding for foreign health clinics that provided abortions or referrals for abortions.
While that's music to the ears of the pro-choice community—Planned Parenthood, the National Organization for Women, et al.—abortion opponents would like this to be the last birthday celebration for Roe. Yesterday they had a "march for life" rally on the National Mall attended by thousands. They're worried that abortions will increase under Obama if, say, Medicaid begins granting coverage for them or U.S. military hospitals start providing them.
What's fascinating to me, though, is how the rhetoric is changing among pro-choice activists who are looking to find common ground with their opponents now that they no longer have to push back against President Bush. Kim Gandy, president of the National Organization for Women, has been emphasizing the need to increase the availability of birth control and reduce the number of unwanted pregnancies. The Center for Reproductive Rights has been urging Obama to stop government funding for abstinence-only education but hasn't lobbied for the more controversial Freedom of Choice Act, which would make abortion a fundamental right for all women.
Indeed, Obama himself appears to be treading warily, choosing not to repeal the global gag rule on Roe's anniversary as everyone was expecting. His statement yesterday struck a conciliatory tone. He spoke of reducing the need for abortion and unintended pregnancies, saying, "To accomplish these goals, we must work to find common ground to expand access to affordable contraception, accurate health information, and preventative services."
In an online forum yesterday sponsored by RH Reality Check, reproductive-rights activists were struggling to come up with an appropriate message to advance their goals, wanting to appeal to Americans at large. They don't want to be known as "pro-abortion" and would like to be inclusive to those who feel morally conflicted about abortion but want to keep abortion legal. Sarah Stoesz, an activist who fought for the recent defeat of the abortion ban on the South Dakota ballot, admitted that "our refusal to acknowledge genuine moral ambiguity is not helpful and does not move the conversation forward."
I wanted to know, though, how much compromise they were willing to make for the sake of unity. For instance, most Americans favor some restrictions on abortions—parental notification, for example. And many don't want any of their tax dollars going for the funding of abortions, which would occur if the Freedom of Choice Act passed. From the discussion, I got the sense that while reproductive-rights activists strongly support FOCA—which Obama said he would sign if it passed Congress—they understood that it probably shouldn't be a top priority because it's too divisive. Oh, and I was corrected on my use of the word funding when it comes to abortions. The activists prefer to use the term coverage as if to describe any medical procedure that's covered by insurance. Trouble is, abortions are still largely viewed in a category all their own.
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The right of federally funded health care providers to decline to participate in services to which they object, such as abortion, is affirmed by a final regulation that has been issued by the U.S. Department of Health and Human Services (HHS) and is on display today at the Federal Register.
Over the past three decades, Congress enacted several statutes to safeguard the freedom of health care providers to practice according to their conscience. The new regulation will increase awareness of, and compliance with, these laws.
"Doctors and other health care providers should not be forced to choose between good professional standing and violating their conscience," HHS Secretary Mike Leavitt said. "This rule protects the right of medical providers to care for their patients in accord with their conscience."
Specifically, the final rule:
-- Clarifies that non-discrimination protections apply to institutional health care providers as well as to individual employees working for recipients of certain funds from HHS;
-- Requires recipients of certain HHS funds to certify their compliance with laws protecting provider conscience rights; and
-- Designates the HHS Office for Civil Rights as the entity to receive complaints of discrimination addressed by the existing statutes and the regulation.
HHS officials are charged with working with any state or local government or entity that may be in violation of existing statutes and the regulation to encourage voluntary steps to bring that government or entity into compliance with the law. If, despite the Department's efforts, compliance is not achieved, HHS officials will consider all legal options, including termination of funding and the return of funds paid out in violation of the nondiscrimination provisions.
The rule has gone on display at the Federal Register and is available here. The regulation takes effect 30 days after its publication tomorrow, Dec. 19, in the Federal Register. However, HHS components have been given discretion to phase in the written certification requirement by October 1, 2009, the beginning of the 2010 federal fiscal year.
HHS officials gave careful consideration to all comments received during the public comment period. The final rule summarizes the breadth and scope of the comments received and articulates the Department's responses to them. Changes to the proposed rule include the reduction of covered entities required to sign certifications of compliance with the regulation, in order to exempt the recipients of HHS funding programs which are unlikely to involve the use Department funds for health services or research activities and, thus, unlikely to be implicated by the statutes and the regulation.
In the preamble to the final regulation, the Department also encourages providers to engage their patients early on in "full, open, and honest conversations" to disclose what services they do and do not provide. While it would strengthen provider conscience rights, the regulation would in no way restrict health care providers from performing any legal service or procedure. If a procedure is legal, a patient will still have the ability to access that service from a medical professional or institution that offers it. For example, the regulation does not affect the ability of medical institutions to provide abortion services in accordance with the law.
The comments consistently bore out the necessity of the regulation to implement the statutes enacted by Congress. Many commenters exhibited a lack of understanding of these laws. Others articulated a general knowledge that conscience protections exist for providers, but the scope of these protections was not always widely understood. Still other comments came from health care workers relating personal experiences of what they perceived to be discrimination on the basis of their personal or religious beliefs.
"Many health care providers routinely face pressure to change their medical practice - often in direct opposition to their personal convictions," said HHS Assistant Secretary of Health, Admiral Joxel Garcia, M.D. "During my practice as an OB-GYN, I witnessed this first-hand. Health care providers shouldn't have to check their consciences at the hospital door. Fortunately, Congress enacted several laws to that end, but too many are unaware these protections exist."
Federal protection of provider conscience rights dates back to the 1970s, when Congress enacted the Church Amendments. The Amendments protect health care providers and other individuals from discrimination by recipients of HHS funds on the basis, among other things, of their refusal, due to religious belief or moral conviction, to perform or participate in any lawful health service or research activity.
In 1996, Congress prohibited federal, state or local governments from discriminating against individual and institutional health care providers (including participants in medical training programs) who refused to, among other things, receive training in abortions; require or provide such training; perform abortions; or provide referrals for, or make arrangements for, such training or abortions.
Provider conscience protections were expanded again as part of the Department's fiscal year 2005 appropriations act. In that law, and in subsequent years' appropriations acts, Congress prohibited the provision of HHS funds to any state or local government or federal agency or program that discriminates against institutional or individual health care entities on the basis that the entity does not provide, pay for, provide coverage of, or refer for abortion.
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Making the contraceptive pill available without prescription will not reduce unwanted pregnancies, says an expert in an article published on bmj.com today.
Sarah Jarvis from the Royal College of Physicians argues that it is a lack of daily compliance with taking oral contraceptives which is partly responsible for the high rates of unintended teenage pregnancies in the UK.
Studies have shown that nearly half of all women taking the oral contraceptive pill miss one or more pills in each cycle, and nearly a quarter missed two or more. These women are three times more likely to get pregnant unintentionally than those who take the pill consistently.
She points out that the availability of emergency contraception without prescription has done little to change the rate of teenage pregnancies.
Jarvis believes that the solution lies in long acting reversible contraceptives such as the coil, or those which can be placed under the skin or injected. They last between three months and three years, and because they are not dependent on patients taking them correctly, are much more reliable than oral contraceptives, she adds.
"Increased uptake of reliable, non user-dependent methods, rather than making a potentially unreliable method of contraception more easily available, has to be the key ", she concludes.
But Dr Daniel Grossman of Ibis Reproductive Health argues that the requirement for a prescription is a barrier to oral contraceptive use in some women.
He points out that if governments are committed to reducing rates of unintended pregnancies and maternal deaths in the developing world, increased access to safe oral contraceptives for all women at low or no cost is vital.
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Connecticut Attorney General Richard Blumenthal (D) on Friday said that he plans to challenge the new HHS provider "conscience" rule, which he said could override a Connecticut law that requires hospitals to provide emergency contraception to women who have been raped, the AP/New Haven Register reports (AP/New Haven Register, 12/20).
The rule, which will take effect on Jan. 18, 2009, allows employees of entities that receive federal grants to refuse to provide medical information and services they object to based on moral or religious beliefs. The more than 584,000 entities that the rule will affect have until Oct. 1, 2009, to submit written certification of their compliance or risk losing federal funding.
Blumenthal said that his actions could include a letter, a petition or a court challenge that would argue that the rule violates states' and patients' rights. "We went through a very lengthy, painstaking, contentious process to reach our statute in Connecticut and it has worked well for everyone," he said, adding, "This administration's new regulation threatens to blow apart that very significant balance of interests and compromises" (Becker, Hartford Courant, 12/20). The Connecticut law, which took effect in 2007, requires hospitals to offer EC to rape survivors, although a third party can be designated to administer the drug. Hospitals also are permitted to conduct a pregnancy test before prescribing EC, but they may not administer other tests -- such as ovulation tests -- as a condition of prescribing the drug. The Catholic Church opposed the law for two years, but a few days before it was to take effect, Catholic Bishops of Connecticut and Catholic hospital leaders issued a statement saying that "since the teaching authority of the church has not defnitively resolved this matter, and since there is serious doubt about how Plan B pills work," Catholic hospitals would be allowed to provide EC to rape survivors without first administering ovulation tests. Four of the state's 30 hospitals are Catholic (AP/New Haven Register, 12/20).
Blumenthal called the new federal regulation "the outgoing Bush administration's latest and last swipe at women's health" and said that it upsets the balance between patients' rights and providers' beliefs. "This rule is an appalling insult and abuse -- a midnight power grab to deny access to health care services and information, even to victims of rape," he said.
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Some women in countries where abortion is restricted are using the internet to buy medication enabling them to abort a pregnancy at home, the BBC has learned.
Women in Northern Ireland and over 70 countries with restrictions have used one of the main websites, Women on Web.
A British Journal of Obstetrics and Gynaecology review of 400 customers found nearly 11% had needed a surgical procedure after taking the medication.
The website says it can help reduce the problems linked with unsafe abortions.
'Stressful experience'
But anti-abortion campaigners called the development of such sites "very worrying indeed".
The research into those who had used Women on Web found that about 8% did not end up using the medication they had ordered.
Almost 11% went on to need a surgical procedure - either because the drugs had not completed the abortion or because of excessive bleeding.
Almost 200 women answered questions about their experiences - 58% said they were just grateful to have been able to have had an abortion in this way, while 31% had felt stressed but found the experience acceptable.
Women on Web posts the drugs only to countries where abortion is heavily restricted, and to women who declare they are less than nine weeks' pregnant.
A US woman, who has a rare medical complication meaning pregnancy is life-threatening to her, described her experience when she used the website while in Thailand.
"Women on Web kept in contact with me via e-mail. The medication arrived through Customs, properly blister-packed, with complete paperwork and a doctor's signature.
"Medication from other websites came in unmarked bottles with no instructions or paperwork - it was quite frightening.
"I was not very far along - only three or four weeks. It went smoothly for me.
"I think it's very important women have this resource to turn to in that situation - and they can need it for a number of reasons."
'Reputable site'
The Family Planning Association in Northern Ireland has had several calls from women considering buying abortion pills online.
The FPA said that on two occasions, women bought drugs without appropriate medical information. They experienced complications and needed aftercare.
Northern Ireland FPA director Audrey Simpson said: "The Women On Web site is very helpful and reputable.
"But for Northern Ireland women, it is encouraging them to break the law - and as an organisation, we have to work within the law.
"We're really concerned about women accessing the rogue sites - we're hearing about it and we know it's happening.
"There are potentially serious medical complications for women from sites which aren't well managed and this could be the new era of backstreet abortions."
Anti-abortion campaigners said they were appalled by such websites.
Josephine Quintavalle, from the group Comment on Reproductive Ethics, said: "This is very worrying indeed. It represents further trivialisation of the value of the unborn child.
"It's like taking abortion into the shadows. These drugs have side-effects and tragedies will increase."
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A new test checks the chemical "fingerprint" of the fluid which surrounds IVF embryos to identify those most likely to implant successfully.
The US developers told a European fertility conference it may improve IVF pregnancy rates by up to 15%.
Selecting the embryo most likely to result in a successful pregnancy is the "Holy Grail" of fertility research.
But clinics currently have to select which to use by assessing embryos under a microscope.
Choosing the right embryo from the eight to 10 candidates usually available is key because if there is any damage, or it has not developed properly, the chances of a successful pregnancy are reduced.
It is also increasingly important as IVF doctors move towards implanting just one embryo per treatment cycle to reduce the chance of a multiple birth.
Pregnancy chance boost
The ViaTestE device, developed by scientists from Yale, can score the metabolic activity of a sample of the fluid from around the embryo using spectrophotometry, which uses infrared light to measure the make-up of a substance.
For example, it is used to tell if milk is full-fat or semi-skimmed.
In this instance, the technology checks the activity of metabolites - the substances produced by the embryo.
The team tested around 500 samples of embryo fluid, without knowing which had implanted successfully.
The embryos had also been assessed in the clinics using the traditional method.
That gave around a 40% rate of accurately identifying the embryos which developed into viable foetuses.
But "fingerprinting" using the new test increased that rate to between 60% and 70%.
From these and other results, the scientists believe using the test could improve pregnancy rates by between 10-15%.
That would increase the success rate for women under 35 in the UK receiving IVF from 30% to 45%.
'Major priority'
Trials of the test will begin in the Netherlands and Sweden later this year.
But Denny Sakkas, associate professor of obstetrics and gynaecology at Yale University, who is involved in the work, said clinics, including those in the UK, would be able to use the test, marketed by Molecular Biometrics, early next year.
He added: "Everyone's aim is to get patients pregnant, so the greatest impact of using this device would be in improving pregnancy rates by the 10-15% which it appears to have the potential to do.
"And with the move to single embryo transfer, selecting the right embryo will become even more important."
Dr Daniel Brison, co-director of the North West Embryonic Stem Cell Centre in Manchester, said: "The technique used by this, and other groups, of using infra-red spectroscopy to select embryos is very promising.
"I have high hopes that this, and or, other metabolic profile techniques will be used in clinics throughout the UK within the next two to three years.
"There is a very real need to improve our IVF success rates as at the moment four out of five attempts don't work.
"If we can get better at choosing the best embryo to implant then we can increase the efficiency of IVF, move towards single embryo transfers and thus reduce the risk to mothers and babies."
But he said further research was needed to confirm the test was useful.
He added: "It will be of most help to mothers who can produce a large number of embryos as there will be more options to choose from.
"Unfortunately it will be less beneficial for women, such as older mothers, who are only able to produce one or two embryos."
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An 11-year-old Romanian girl who is 21 weeks pregnant after being raped by an uncle will be able to have an abortion, even though it is forbidden by law.
A government committee said the procedure should go ahead due to the exceptional circumstances of her case.
Romania's abortion limit is 14 weeks. It had been suggested the girl might travel to the UK for the abortion.
Some 20 Christian Orthodox groups had threatened to press charges if the girl was allowed to abort the foetus.
In a letter to the government committee, the girl said she wanted to be able "to go to school and to play".
"If I can't do this my life will be a nightmare," she said, according to a text read out by government committee member Vlad Iliescu.
"The committee has decided that a voluntary termination of the pregnancy can be carried out," said Mr Iliescu.
He said the abortion could take place because the girl was a victim of sexual abuse and faced "major risks to her mental health" if the pregnancy continued.
Another committee member, Theodora Bertzi said the decision was made focusing on "the rights of this child who was subjected to rape and incest".
The committee said the case highlighted the need for "clarifications with regard to the exceptional circumstances" that would allow late-term abortions to go ahead.
'Family decision'
The girl was raped by a 19-year-old uncle who has since disappeared.
Her family only discovered she was pregnant when they took her to the doctor because she seemed sick.
While some pro-life Christian Orthodox groups had urged the family to keep the child, and offered to raise it in a church institution, the Romanian Orthodox Church said any decision on abortion should be left to the family.
The girl's parents had said they wanted to travel to a country where such a late-term abortion was legal.
In Romania abortion is only normally allowed beyond 14 weeks if the mother's life is deemed to be at risk. In Britain, they can be carried out up to 24 weeks in some circumstances.
A Romanian living in the UK had offered to cover the costs of a termination there.
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Abortion, termination of a pregnancy before birth, resulting in the death of the fetus. Some abortions occur naturally because a fetus does not develop normally or because the mother has an injury or disorder that prevents her from carrying the pregnancy to term. This type of spontaneous abortion is commonly known as a miscarriage. Other abortions are induced—that is, intentionally brought on—because a pregnancy is unwanted or presents a risk to a woman’s health, or because the fetus is likely to have severe physical or mental health problems.
Induced abortion, the focus of this article, is one of today’s most intense and polarizing ethical and philosophical issues. Modern medical techniques have made induced abortions simpler and less dangerous. But in the United States, the debate over abortion has led to legal battles in the courts, in the Congress of the United States, and state legislatures. The debate has spilled over into confrontations, which are sometimes violent, at clinics where abortions are performed.
This article discusses the most common methods used to induce abortions, the social and ethical issues surrounding abortion, and the history of the regulation of abortion in the United States.
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