Posts by Lily
Posted on 6.13.2013 by Lily
So a lot's been going on with Plan B lately, yeah? Let's recap the events of the last few months:
In April, Judge Edward Korman raked the Obama administration over the coals for playing politics with emergency contraception and ordered them to grant the 2001 (yes, really) Citizen's Petition to make Plan B over-the-counter with no age or point-of-sale restrictions whatsoever.
In May, the Obama administration appealed his order because why not drag this endless saga on for as long as humanly possible? Why not maximize the number of days in which women's lives are changed forever because they can't access EC? Meanwhile, the FDA was off making a sweetheart deal with Teva (the company that manufactures one brand of EC) to lower the OTC age to 15+, but give Teva's brand OTC market exclusivity. I explained a few weeks ago why this policy, despite the lowered age from 17 to 15, would actually make the situation more harmful to girls and women than the current 17+ behind-the-counter status.
Last week, the Obama administration was ordered to make the two-pill version of EC immediately available over-the-counter. A few days ago, they responded by announcing that they would drop their efforts to restrict sales of the one-pill version (also known as Plan B One-Step). The two-pill version, however, they still want restricted since young girls might be flummoxed over having to take so very many pills! I mean, two pills versus one, that's tricky - math is hard, amirite girls? Good thing we have the Justice Department protecting us from straining our pretty little brains over figuring out how on earth you take two pills that come together.*
Anyway, all the different policy proposals and rulings and orders are convoluted and confusing and pretty emblematic of this decade-plus long struggle to get emergency contraception, arguably the safest medication in existence and one of the most critical for women's health, to be sold simply like Tylenol and condoms so that everyone who needs it can just… go ahead and buy it.
Pro-choice advocates like Cecile Richards, president of Planned Parenthood Federation of America, and Nancy Northup, president of the Center for Reproductive Rights, are hailing these most recent events as "huge victories" and "historic moments" for women's health and rights. "Finally, after more than a decade of politically motivated delays, women will no longer have to endure intrusive, onerous, and medically unnecessary restrictions to get emergency contraception," said Northup after the Second Circuit Court of Appeals ordered the administration to make the two-pill version available OTC.
Really, Nancy Northup? Really, Cecile Richards?
I recognize these are good steps forward, but I see them as that: baby steps forward. And not baby steps over the finish line, either. I think maybe I can see the finish line from here, but it's still a ways off.
It's either overly optimistic, naïve, or politically calculated to say that women are no longer going to face unnecessary restrictions to getting emergency contraception. We don't know exactly what the details of the policy will look like; the Obama administration submitted their retraction of appeal to Judge Korman, who still has to approve it. (And he doesn't take any shit, so we'll see if what they proposed is good enough for him!) Then, perhaps most importantly, we'll see what happens with brand names versus generic EC and market exclusivity. Plan B can run pretty expensive – over $50 is not uncommon for a pack, and a generic can be about $35, which is still fairly pricey for a one-time medication. If Teva has market exclusivity on Plan B One-Step on store shelves, as I delved into previously, it was estimated that the pill would cost over $60. Obviously the difference between brands and generics matters. If Plan B is now available OTC without age or point-of-sale restrictions, but the only OTC option costs over $60, are we really better off? Are the women and girls who are most disadvantaged – the ones who stand to benefit the most from a policy change – really going to be better served when they can get the pill without a prescription and without having to show ID, but they have to cough up more than $60 to do so?
I can't celebrate this news yet. Not until I know exactly how it's going to be put into place: what's going to happen with generics, will Teva have market exclusivity, what will prices be, whether they'll ever stop this ridiculous game of distinguishing between the one-pill/two-pill versions as though they're not the same exact damn thing, will EC actually be more accessible and affordable to everyone who needs it. Time will tell. All I can say now is that while we're seeing some cautiously good news, it's just the next agonizing slow step in the right direction in our country's sordid history around this life-changing medication. It's really not a historic moment, so let's not get out the champagne just yet.
*I do admit that there is a disadvantage to the two-pill version in that the instructions still in many cases say to take the two pills twelve hours apart. This is unnecessary; taking the two pills together, as if they were one pill, is just as effective as taking them twelve hours apart, and much simpler. Women following the twelve-hour instruction are more likely to forget the second dose, which renders the regimen useless. But this is a problem of the packaging instructions, which should be changed to reflect the two-pills-together guideline; moreover, paternalism is not a good reason to keep the pills behind the counter – especially when there are generic two-pill versions that could be a lot cheaper than the one-pill OTC version.
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Posted on 5.31.2013 by Lily
Note: This post is part of our collective blog remembrance for Dr. Tiller on the 4th anniversary of his murder.
About ten months ago, a 16-year-old girl in the Dominican Republic died of complications from leukemia after doctors spent three weeks withholding chemotherapy because she was pregnant.
About six months ago, Savita Halappanavar, a 31-year-old woman who was 17 weeks pregnant with a non-viable and dying fetus, died of blood poisoning when the hospital she went to in Ireland refused her a life-saving pregnancy termination.
Today, Beatriz, a 22-year-old mother with lupus and a high-risk, non-viable pregnancy lingers in an El Salvador hospital as her 26-week pregnancy endangers her life a little more every day. The Salvadorean Supreme Court decided that she would not be permitted a life-saving abortion, which essentially amounts to a death sentence, as Beatriz's doctors have assessed that continuing the pregnancy will likely kill her. They did decide she could be allowed a premature delivery by C-section - despite that the C-section is far riskier to Beatriz and, y'know, the fetus still won't survive. (You can support Beatriz's cause here.)
These are only a few stories. No doubt there are countless other women like Beatriz, Savita, and the anonymous 16-year-old who do not come into the grip of the world's attention, inspiring international frenzies and calls for justice.
Now another story. Four years ago today, Dr. George Tiller, perhaps the most well-known provider of second and third trimester abortions in the United States, was gunned down in his church in Wichita, Kansas, by a radical anti-abortion domestic terrorist.
What do these stories have in common? They are all about killing under the guise of "pro-life." None of these stories support life in any way that I understand it.
Dr. Tiller specialized in helping women no one else would. People flew to see him in Kansas from all over the country. They never expected to need his services. But pregnancies and life circumstances take unexpected twists and turns, and Dr. Tiller helped those in devastating circumstances who often found themselves needing to terminate desperately wanted pregnancies.
I imagine all but the most ardent anti-abortion folks believe that Beatriz should be "allowed" an abortion. After all, without one, both mother and fetus will likely die, which is surely a worse outcome than only the fetus dying. And they might think such a situation as is playing out in El Salvador today would never come to pass in the U.S. Of course, we would always do what needed to be done to save the patient, under circumstances so cut-and-dry.
But here's the thing. It's never cut-and-dry. There's no line dividing Beatriz from Dr. Tiller's patients. You may have your own guidelines for when an abortion is acceptable; when the patient has a 95% chance of dying, perhaps. 75%, 50%. If the fetus has this condition, or that one. If it definitely won't survive outside the womb. If it probably won't. If the woman was raped.
Who decides? Who decides how bad it has to be, how dire a woman's situation, how heart-wrenching her story, how sympathetic her character or the circumstances surrounding the conception? Who decides?
In El Salvador, a few judges decided - and took their sweet time, too, which is why Beatriz is now 26 weeks pregnant. Because that is what happens when abortion is illegal. Yes, there are varying degrees of legality, and few countries' laws are quite so harsh. But when you take the ability to handle a pregnancy out of the hands of the pregnant person and her medical team, well, a woman might very well end up wasting away as her pregnancy kills her a little more each day, waiting for some powerful people far away who don't know her to decide her fate.
Another woman might quietly languish at home, her physical health okay while she agonizes over how this child will fare when her three others already go to bed hungry. Maybe she thinks it would be more merciful to not bring this child into the suffering.
Maybe another woman's pregnancy is viable - so far - but when her husband beats her up, she fears for both her own and the baby's safety - and fears the child being born into that home even more.
Maybe another woman's physical health is okay, and she isn't being abused, and the pregnancy is healthy. But her depression grows by the day, and she may well become suicidal if the pregnancy continues.
Who decides?
Dr. Tiller famously wore a pin that said "Trust Women". With him gone, fewer women are trusted with their own bodies and lives.
It seems like every day there's another restriction on abortion in this country. Another TRAP law, another 20-week ban, a parental consent law. There are no sensationalized stories about the woman who goes bankrupt to pay for an out-of-state and later abortion because her local clinic closed for not having wide enough hallways. The pregnant teenager living in such fear and denial, unable to tell her parents as her pregnancy progresses past the point of decision, doesn't make the headlines. The patient weeping at the clinic where she found out she is two days past the 20-week cutoff, and now bewildered and lost with no idea where to go, doesn't inspire an international outcry.
All of them should.
Dr. Tiller's death left a gaping hole in American women's health care. Today, four years after his brutal assassination, it's even more crucial that we honor his memory and trust women - here and everywhere.
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Posted on 5.31.2013 by Lily
May 31, 2013 marks the fourth year since Dr. Tiller, an abortion provider in Wichita, Kansas, was brutally murdered while serving as an usher in his church. Dr. Tiller was known worldwide as a provider of compassionate, kind, respectful later abortion services that focused on preserving the dignity and integrity of his patients.
To honor his legacy, the Abortion Gang and the Provider Project asked folks to reflect on later abortions. Below is a list of posts taking on this topic and thinking about Dr. Tiller. This list will be updated as the day goes on:
Dr. Tiller, Beatriz, Savita, and all the others
Dr. Tiller Remembered
The Legacy of Dr. George Tiller
Remember
In Memory of Dr. Tiller, on the Fourth Anniversary of his Death
Remembering Dr. Tiller
Dr. Tiller was my abortion provider and he changed my life
On Anniversary of Dr. Tiller's Murder, Anti-Abortion Harassment is Still Hurting Women and Doctors
To Honor George Tiller's Legacy, Give to an Abortion Fund
Four Years After Murder of Dr. George Tiller, His Wichita Abortion Clinic Reopens Despite Threats
If you've written a post in honor of Dr. Tiller and don't see it above, please email the URL to lily@theproviderproject.org, tweet the link to @ProviderProject, or leave it in the comments.
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Posted on 5.29.2013 by Lily
This Friday, May 31, 2013 marks the 4th anniversary of Dr. George Tiller's murder. One year ago, we at the Provider Project and the Abortion Gang hosted a collective blog call for remembrance in his honor, and we'd like to make this an annual tradition. Unfortunately, threats against abortion providers are still all too real and we are fighting an ongoing battle against abortion restrictions across the United States. This year has seen a surge particularly in laws banning abortion after certain points in pregnancy, from a 12-week ban in Arkansas to the recent proposal to ban abortion nationwide after 20 weeks. Dr. Tiller was widely known for his 2nd and 3rd trimester abortion care, and it was ultimately his unwavering commitment to providing these services that was the reason for his assassination four years ago.
In light of that, we'd like for posts this year to address the question of those abortions performed in the 2nd and 3rd trimester that are most threatened legally right now. Your post could use some of the following questions as jumping-off points:
Why are there so few 2nd and 3rd trimester abortion providers in this country? How can we improve the situation so that more doctors provide this care?
Why is it so important that abortion remain legal past 20 weeks?
How would a nationwide 20-week ban affect the country, or your community? How might it affect your personal reproductive health decisions?
In your post, please link back to this blog post so that folks can come here and find links to other reflections on Dr. Tiller.
The Abortion Gang and The Provider Project will post links to pieces written answering this question, starting Friday, May 31through the following Friday, June 7. Please feel free to forward this call for posts to anyone who you think would be interested in honoring Dr. Tiller’s legacy. Send the links to your posts to info@iamdrtiller.com and lily@theproviderproject.org, tweet them to @AbortionGang and @Provider Project, or leave them in the comments.
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Posted on 5.16.2013 by Lily
Official Plan B One-Step and FDA guidelines still say that the levonorgestrel emergency contraceptive must be taken within 72 hours (3 days) after unprotected sex. Working in reproductive health, it's easy to forget that the standard 120-hour guideline is still technically off-label, since every single other health authority cites it. But even if the 120-hour guideline is the one most often followed in clinics and by sexual health experts, pharmacists dispensing the medication won't instruct off-label use, and patients could figure it's not worth it after reading the drug labeling.
Yes, it's always better to take EC as soon as possible. But a patient should not be discouraged from taking EC after 72 hours because it CAN still be effective for two more days, and it's time that the official FDA instructions reflect that.
Why exactly has the FDA not caught up with standard medical practice on this? Oh right, possibly because they're corrupt, overtly politicized, incompetent drug company panderers who put women's health last.
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Posted on 5.14.2013 by Lily
A new chapter is presently unfolding in the interminable 12+ year struggle to get levonorgestrel-based emergency contraception (EC), commonly known as Plan B or the morning-after pill, sold over-the-counter with no age restriction on retail shelves. The safety of EC cannot be overstated. It has been attributed to NO deaths, NO serious complications, and has NO contraindications besides a specific allergy to levonorgestrel (which nobody has, since it's just a synthetic version of hormones made naturally by your body). It could basically be the safest drug ever to be sold in places like convenience stores, gas stations, and supermarkets. I can't think of a single other OTC medication that boasts the same safety profile - and all of those are sold without age restrictions, despite many being labeled as not for pediatric use.
First, a brief timeline of events in Plan B's sordid history.
-1999: Approved as a prescription-only drug for women of all ages.
-2001-2006: Bush packed the FDA with his cronies over actual scientists, who blocked progress for years, despite their own advisory panel voting 23-4 in favor of OTC status in 2003. (Yeah. We could have been done with this circus 10 years ago.)
-2006: We started taking baby steps forward. First EC went behind-the-counter for women over 18 who could prove their age. (Despite, yet again, the FDA recommending in 2005 that the age limit be lowered to 17.) Behind-the-counter is sort of like over-the-counter in that you don't need a prescription, but it doesn't really improve access very much, because the pill could still only be sold in pharmacies and not retail establishments that sell much more dangerous drugs like aspirin, caffeine, and Tylenol. Under this status, Plan B is less accessible than cigarettes, which are also behind-the-counter, but sold everywhere from supermarkets to gas stations and not subject to pharmacy hours. And so Plan B remained inaccessible to women under 18 without a prescription, and stayed difficult to access for all women.
-2009: The behind-the-counter age restriction was lowered to 17 on U.S. District Judge Edward Korman's orders (more on him below), and a generic version (Next Choice) became available. And that's been the status quo since.
-2011: The FDA, now composed of actual scientists, was poised to allow all levonorgestrel-based emergency contraceptives to be sold OTC with no age restriction. We rejoiced! No more incremental steps forward, no more lowering the age one year at a time while the pill languished behind pharmacy counters, off-limits to women under 17, women who can't prove their age, women who got to the store after the pharmacy was closed. It was really about to happen! ...For a few hours, anyway.
Because Kathleen Sebelius, Secretary of Health and Human Services and longtime pro-choice advocate, bewilderingly betrayed us in an unprecedented move of overruling her own scientists and blocking the policy they were set to implement at long last. Why? She didn't think they had showed that the pill would be safe for 11 and 12-year-olds. Of course, she based this unprecedented and outrageous interference on her years of medical experience and many impressive scientific credentials. Just kidding! She actually had no qualifications whatsoever to make that judgment, and it was really just a political maneuver in our little American game of thrones that, once again, sacrificed women's health. (Hey, we're pretty used to it at this point. Just not from people we thought were our allies.) President Obama, who campaign-promised to return public health policy to science after the horrors of the Bush years, publicly supported her decision. Or was really the one behind it, a year before his re-election. Who knows.
And that's how nothing changed for another year and a half. It is not unreasonable to suggest that thousands upon thousands of women have gotten pregnant unintentionally since Sebelius's intervention because they couldn't access EC in a timely fashion. Roughly 50% of those pregnancies likely ended in abortion.
And that brings us to the present. Well, as of last month, when my current hero Judge Korman - who has been involved in this struggle for years - overturned Sebelius's decision and ordered that all levonorgestrel-based emergency contraceptives be sold OTC with no age restrictions within 30 days. He also told the government just what he thought of their actions in no uncertain terms: they were "arbitrary, capricious and unreasonable" as well as "politically motivated, scientifically unjustified, and contrary to agency precedent."
The government is appealing his ruling, because why admit defeat in their shameful game now? Judge Korman's order was supposed to go into effect this past Friday, though he agreed to delay it until yesterday to allow the government to file their appeal. But! What has the FDA been up to in the meantime? Well, a few weeks ago they approved a policy to lower the age for OTC access from 17 to 15, and to put the medication on pharmacy shelves rather than behind-the-counter. This is happening even if the government wins their appeal against Korman's order to remove the age restriction altogether. So even worst case scenario, we still get a net benefit, right? Another maddening incremental step in this ridiculous 12+ year process, but at least going in the right direction. Right?
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Posted on 10.25.2012 by Lily
This time, it's that pregnancies resulting from rape are God's will. Wait. Rape can lead to pregnancy?! Even legitimate rape?
Anyway, all I can say is that Stephen Colbert is keeping me sane through this election season. Is it November 6 yet?
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Posted on 10.09.2012 by Lily
As a friend of mine wrote when I posted the story about this study on Facebook the other day, that is some embarrassingly circular logic.
In other words, those of us who subscribe to reality knew this already.
The project tracked more than 9,000 women in St. Louis, many of them poor or uninsured. They were given their choice of a range of contraceptive methods at no cost — from birth control pills to goof-proof options like the IUD or a matchstick-sized implant.
When price wasn't an issue, women flocked to the most effective contraceptives — the implanted options, which typically cost hundreds of dollars up-front to insert. These women experienced far fewer unintended pregnancies as a result, reported Dr. Jeffrey Peipert of Washington University in St. Louis in a study published Thursday.
Not surprising. Unfortunately, as Kelly well knows, many women do have price as an issue when considering their birth control options. For uninsured women, or women who don't have contraceptive coverage, the upfront cost of an IUD or implant - which can range from maybe $400 to over $1000 - is absurdly prohibitive. So what often happens is that they stick to using something like the pill, with monthly co-pays that probably end up costing more in the long run, but are more manageable in the short term. And since typical use of the pill, which must be remembered daily, is not nearly as effective as implanted devices that you get to forget about completely, these women are far more likely to experience an unintended pregnancy.
Unfortunately, this embarrassingly circular logic does not usually lead to its embarrassingly obvious solution: make contraception, especially the long-term, reversible types like the IUD and implant, as widely available and accessible as possible. Everyone should be able to agree on this no matter their feelings on abortion.
But those who fight against abortion aren't really just fighting abortion, are they? They're not really fighting abortion at all, actually, only fighting for it to move underground and become more dangerous. Those of us who work to provide birth control services and education do more to reduce the number of abortions than the anti-choice movement ever has.
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Posted on 9.26.2012 by Lily
I found this pretty awesome post recently about how to help a woman in labor. It’s written by a trained birth doula, and I totally want to be a birth doula now too. Besides childbirth just being fucking cool, I’m pretty sure that being with women through labor and delivery would give me mad skills to improve how I help women through their abortions, too.
See, I’m officially a counselor, but I like to think that the term “patient advocate” describes what I do better than counseling. I try however I can to make patients’ experiences with us the most comfortable and positive they can possibly be, and that goes beyond the counseling room. One way I do that is by being a support person through the actual surgery for patients who want it - basically, acting as an abortion doula.
There is no one way that patients experience abortion. As many people as there are who choose abortions, there are experiences with it. And particularly with local (awake) abortions, I’ve been amazed by how dramatically different two people’s experiences can be. For some women, an abortion is intensely painful. Others barely seem to notice what’s going on between their legs. Most, I would say, are somewhere in the middle.
But for every kind of patient, an abortion doula can make an incredible difference. Just as there is no one abortion experience, there is no one way to be a patient’s support throughout her abortion. Some patients want to know exactly what is going on during the procedure, and so I’ll explain every step of the process, what the doctor will do next, and how it will feel. Other patients would rather stay distracted, so we make small talk. Some patients want a hand to squeeze, and I’ll coach other patients on breathing through the procedure.
I try to be there for them before and after the abortion, too. Our rapport begins in the counseling room, but if I can I’ll try to be the one to bring the patient into the OR and help her get set up. It’s nice to have that person be someone the patient already knows a little, rather than yet another new face. And I’ll try to spend some time with them in recovery.
It makes an enormous difference. And patients are incredibly grateful.
Abortion care everywhere should have the doula philosophy at its core. It should underline every. thing. we do.
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Posted on 8.23.2012 by Lily
Re: Todd Akin, I just can't even.
Re: TRAP law shuttering a Tennessee clinic, I can't. I'm glad Amy did. But I can't.
Paul Ryan. "Legitimate" rape. Official GOP party platform. Transvaginal ultrasounds. Waiting periods. 20 week bans. Sex selection. Lila Rose. Insurance (non-)coverage. A 16 year old dying of cancer because she's also pregnant. Etc. Etc. Etc.
I can't. I have what Jezebel aptly named rape fatigue, except it's Misogyny And Everything fatigue. I can't get properly outraged at every outrageous thing. I wouldn't have anything left.
It seems like every day there's another setback to our rights. Another shameful law making it that much harder to access vitally needed, life-saving health care. Another vile politician spouting off nonsense they know nothing about and making it that much clearer just how much these people should not be legislating health care. And, well... it just gets to be too much. Plus my job, it's just too much.
I don't even read a lot of feminist commentary about all the terrible stuff that's going on anymore. I used to devour the feminist blogosphere, back when I was in college and not living abortion every day. And I got outraged.
Now I live abortion every day. And with abortion I work with women. I work with birth control, and I work with the lack of access to it and education around it. I work with rape, and domestic violence, and the very real pregnancies that result. I work with young women, and poor women, and women of color, and undocumented women, all of whom have their own set of unique challenges to obtaining the health care they need.
I love abortion care dearly and can't imagine my life without it, but damn, is it hard. It's nonstop emotional, and it's seriously draining. Sometimes it's uplifting and empowering and beautiful, and sometimes it's terrible. Patients are at once wonderful and awful. Sometimes patients thank me, so sincerely, so heartfelt, so grateful for our service that they're in tears, and it makes it all worth it. Sometimes patients scream at me and I wonder why I do this. Most days involve some mixture of everything.
It's difficult to come home after a day of living abortion and to go on Facebook to unwind, only to see my news feed exploded with the asinine comments of some douchebag Republican about how only "'legitimate' rape victims deserve access to abortion." And I want to scream and cry and I wish he would live my job for a day and learn the truth.
And then I get up and go back to my job the next day.
I'm incredibly fortunate that with the plethora of laws introduced lately to restrict abortion care, Connecticut has remained unscathed. As I mentioned a little while ago, we have it really, really good. I'm lucky that I can JUST be drained by the daily reality of my job, without all the added absurdity going on elsewhere in the country. I may have to find out what it's like to be the target of a TRAP law, or worse, but I honestly cannot even imagine it. This job is hard enough.
And that's why I blog about the ins and outs and ups and downs of direct service in the field of abortion care. (Thanks, Abortioneers!) What's going on in the news is obviously important and outrageous and we need to be aware so we can fight back. But people also need to know just what this work actually IS. What I do every day. Who my patients are. That abortion care is love and life and everything beautiful and terrible, that it's the TRUTH. Abortion is the truth, because we've always had it and we always will, no matter what laws are on the books or what the politicians say.
So yeah, more blogging about my actual work and less about what's going on in the world outside my clinic walls. Because my actual work is what gets me through, and my actual work is what will still be here every day even after the media spotlight fades away on this latest uproar. I'll still be doing this amazing, life-saving, incredible work, and that's my response to Todd Akin.
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Posted on 8.10.2012 by Lily
AlterNet has a great profile up of Women on Waves, which, if you haven't heard of them, is a bad-ass organization that travels around the world providing safe medication abortion in countries where abortion is illegal or restricted. They accomplish this - legally - by traveling by ship and docking in international waters outside the country in question, and then bringing women who need abortions aboard, where their doctor, founder, and pretty much all-around kick-ass superhero Rebecca Gomperts supervises their medical abortions. Oh yeah, and their sister organization, Women on Web, sends medical abortion pills through the mail. Seriously. Bad. Ass!
According to the article, Women on Waves has been influential enough to inspire various countries to ban misoprostol, which is one of the two main medications used in medical abortion. Unlike mifepristone (the drug formerly known as RU-486, or "the abortion pill"), misoprostol has other uses besides its abortifacient properties. It's primarily approved as an ulcer treatment, and so is widely available in many countries without a prescription for this purpose. Women on Waves' impact has been as much about spreading the information about how to safely access medical abortion as it has been about the actual abortion provision; they now train international women's groups to educate the populace to access and self-administer at-home abortions using misoprostol.
In fact, due to the increased popularity and awareness surrounding medical abortion, the face of illegal abortion has largely changed since the "coat-hanger" days. Which is good, since self-inducing a medical abortion is way, WAY safer than any attempt to manually terminate a pregnancy. (Unless you have an Ipas system and know how to use it, I suppose.)
I've been thinking about medical abortion a lot lately in light of all the recent restrictions on abortion access in the US. In some places, abortion is as good as illegal. I don't know how women in these areas who need abortions are handling it. Probably they're traveling if they can, but according to the AlterNet article, Women on Web's US help desk has seen a surge in calls lately. Which isn't surprising, but I wonder how many of these women - if any - are able to get help from WoW. According to their website, they only help if you live in a country "where access to safe abortion is restricted." Technically, I don't think the US fits the bill, although we all know "access" is relative.
So the upshot of all this is that women in developing countries where abortion is completely criminalized might actually have better, safer access to abortion in some cases than American women:
In many countries where abortion is illegal, women can still purchase Misoprostol from a pharmacy for as little as $1 in Pakistan, for instance, and $12 in Morocco. Gomperts said it might ultimately be easier for women in Africa to terminate their pregnancies than women in Missouri where abortion is technically legal. This is not to say that the struggle for reproductive rights is easier for women outside the U.S., but rather, that in countries with less regulation, side-stepping the law is simpler and safer in this case.
I don't know what illegal abortion would look like in the US today - or what it already looks like. Misoprostol is only available with a prescription. No doubt black market versions exist, but as with all illicit drugs, there's little guarantee of either authenticity or safety. However, I am glad simply for more widespread knowledge and education about these medications. Hopefully, even under illegal abortion, the coat-hanger will fade into obsoletion.
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Posted on 7.25.2012 by Lily
In the midst of all the abortion storytelling that's been going on lately, I wanted to highlight two recent articles that bring different perspectives to the table. You may have seen the first one if you've been following recent abortion stories, called "Why I Won't Come Out About My Abortion." The anonymous writer writes,
My abortion is no one's business. My abortion is something that should be between me and my doctor, and going public with the details in an attempt to destigmatize choice could ruin my career. So why would I ever "come out" about it?
She continues,
Wearing a tee-shirt that reads "I had an abortion" might remind the average Joe Abstinence Only Education that all kinds of women have abortions and they're not all irresponsible sluts trying to erase their mistakes by taking the easy way out, and that they don't all look like Courtney Love during the nineties. But coming out pressure from women's groups places many women in an awkward position: do what's being asked of you for the greater good, and all of the risk falls on your shoulders, while all of the reward goes to the movement. That's hardly incentive to come forward. Remaining silent is an act of self-preservation.
Which ties into the second piece I've been thinking about lately, called "'Coming Out' on Abortion: Who Wins?" written by Kai Gurley of the Abortion Access Project. Gurley argues that the abortion rights movement is taking its cues from the queer rights movement in putting pressure on women to "come out." The problem is that being out, whether about sexual orientation or having had an abortion, can also be dangerous:
But there is a limit to this thinking – with all of the culture change that the LGBTQ community has seen, stigma and violence are still perpetrated every day. I was reminded of this as I read the story of Mollie Olgin, 19, and Mary Chapa, 18, two young lesbians who were shot (with Mollie being killed) in Texas just last month. And I am heartbroken, remembering exactly how terrifying it is to be a 17-year-old kid coming out in the South, and how challenging moving through the world in this queer body of mine continues to be. [...]
Similarly, abortion providers, clinic workers, and the people that utilize their services experience violence and harassment every single day. The National Abortion Federation reports 5,165 incidents of violence and disruption at abortion clinics in 2011 alone, including stalking, vandalism, picketing, and attempted bombings and/or arson. [...]
If the abortion rights movement is going to ask women to be more visible and vocal about their experiences with abortion, we must do so with thoughtfulness about the potential impact on individual people – particularly people living in rural communities and conservative states. We must be working to address stigma in these communities. And we must be vigilant about supporting people – providers, clinic staff, and individual women – once they go public.
Go read the whole thing. It's powerful stuff. She's 100% right that the call to "come out" about having an abortion needs to be done thoughtfully and sensitively, with regard for the circumstances that may make coming out risky for people in different communities. Depending on your circumstances, demographics, community, and a million other factors, coming out can be an act of privilege. Or it can put your life in danger. And tying back to the first piece, of course coming out needs to be a personal decision made by the individual who knows her life and situation best.
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Posted on 7.12.2012 by Lily
Steph Herold wrote an important piece and started an even more important project earlier this week that you need to check out if you haven't already. Here's her introduction:
Over the last few months, there's been an electric energy around the sharing of abortion stories. We've seen two stories in the New York Times, a Jewish abortion story on Kveller, a continuation of an abortion story on Thought Catalog, an early abortion story on Boing Boing, and a piece by a woman reflecting on the consequences of telling her abortion story in the Texas Observer. One woman even documented her abortion in photos. And that's just recently.
This recent wave of abortion storytelling gives me hope, which is hard to come by these days. Those of us working in the field have long said that sharing our stories is the only way (or the most powerful way) to combat the stigma and shame surrounding abortion. Since at least one in every three women has at least one abortion in her lifetime, it's hard to imagine that the stigma could continue if each and every one of this massive global community were open and honest about their experiences. If only abortion were openly discussed as a normal and common experience, part of the range of reproductive and sexual health experiences we have throughout our lives.
But I feel conflicted about one of these stories that's been making the Internet rounds lately. Specifically, I want to talk about the last one mentioned above, the abortion documented in photos.
This project represents a new type of abortion storytelling. The use of photos in abortion politics has been largely confined to the Photoshopped variety on the protesters' signs. Dispelling the lies of those signs seems to be the primary motivation of this patient who took pictures of her abortion.
I understand and applaud these intentions. It's true that a 6 week abortion bears no resemblance to the gruesome pictures of developed fetuses that decorate the sidewalks outside our clinics. In fact, a 6 week abortion is mostly a lot of blood and uterine lining, which is what you see in these photos. The actual embryo is so teensy and unlike any image of a baby you've ever seen that it takes a specially trained eye to find and separate it out from all the other tissue. You’re not actually even looking for the embryo at that stage; you're looking for the gestational sac containing it. Which can still be hard to find. It took me a while to be able to do it, and I know a little something about abortion.
But I have to admit that my first reaction upon seeing the site was not to applaud the woman behind it. My first reaction was more along the lines of what the fuck don't record undercover in our clinics.
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Posted on 6.26.2012 by Lily
So Mississippi’s only abortion clinic is being threatened yet again. Except this time they may actually have to shut their doors. Did I mention it’s the ONLY clinic in the great state of Mississippi? Yeah.
I’m a born ‘n’ raised New Englander, which means I have a vague sense of the rest of the country with Florida below us and California over on the other side and Texas near Mexico, and a whole mess of states in the middle. Growing up in New England means my sense of distance is, well, relative. I have lived and worked in abortion clinics in Massachusetts, Connecticut, and Rhode Island, which needless to say, are very small states that can be crossed in a matter of hours. Or less than one hour, in Lil Rhody’s case. My family would periodically go to New York City, which took about 3-4 hours depending on traffic. Sometimes we would take the really dreadfully long drive to Philadelphia - about 6 hours.
The point is, in the Northeast, everything is pretty close.
And New England’s got a few abortion clinics to boot. The situation facing patients seeking abortions in New England is not great - because it’s not exactly great in this country, period - but I'm willing to bet it’s a whole hell of a lot better here than in much of the rest of the country, save California and a handful of other, probably mostly Northeastern states. (Forgive my Northeastern-blinded ignorance of the rest of the country.) I’d like to compare the situation in my beloved New England to the situation facing millions of patients in the rest of the country - especially, as is timely right now, in Mississippi.
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Posted on 6.13.2012 by Lily
So I was super excited about Girls, HBO's new comedy series that's been critically acclaimed, roundly condemned, examined from every angle, and then written about some more. And I'm going to do the same thing, but from the perspective of a sexual and reproductive health provider analyzing TV's depiction of these subjects.
I started to watch Girls because I like women, and funny women, and women-centered shows. I think we need more of them on TV. I also loved Sex and the City and will defend it wholeheartedly, and Girls had been called the updated version. (Probably because there are so few women-centered shows on TV that anything surrounding a group of female friends has little else to be compared to, but anyway.) Long story short, I read a lot of criticism and then I wanted to see for myself.
I watched the first episode simultaneously with my brother who lives in another state. He'd been even more excited about it than me, and we planned to watch it "together" like we had watched Popular back in the day.
Then, about halfway through the episode, he texted me: "I think I hate it." I could only agree, sadly. My lip had been curled up in disbelief since probably that first painful scene where Hannah's parents tell her that two years out of college is long enough to have supported her as she writes her "memoir" and works an unpaid internship, and Hannah reacts with a temper tantrum.
My distaste wasn't even really about the whitewashing of New York City or the showcasing of privileged white people problems when the show's title falsely connotes a universality of experience. It was just that the characters, in my brother's words, were all so odious. Seriously, these are not likeable people. And not even in a funny way. More like in a "what's the point and why am I watching this" kind of way. At least that was my first impression.
But the second episode was called Vagina Panic and supposedly had an abortion storyline. And that's pretty much all I need to know to be there.
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Posted on 5.31.2012 by Lily
Cross-posted at Abortion Gang.
May 31 marks the third year since Dr. Tiller, an abortion provider in Wichita, Kansas, was brutally murdered while serving as an usher in his church. Dr. Tiller was known worldwide as a provider of compassionate, kind, respectful later abortion services that focused on preserving the dignity and integrity of his patients.
To honor his legacy, we and the Abortion Gang asked folks to respond to this question: How can the pro-choice and reproductive justice movements better support the people who have later abortions and providers who perform them? Below is a list of posts taking on this topic and thinking about Dr. Tiller. This list will be updated as the day and week go on:
Patient first
May 31, 2009: Welcome to America
What Would George Tiller Do?
Keep Late-Term Abortions Available
The Good Samaritan
Dr. Tiller Would Trust Women
Thoughts on the Anniversary of Dr. Tiller's Death
Thinking about Dr. Tiller
I Write Letters
An anniversary of a loss
We are the moral side
Remembering Dr. George Tiller
The Terrorism That Killed Dr. Tiller Remains a Threat
This Clinic Stays Open: Remembering Dr. Tiller
Honoring Dr. Tiller
Three Years Later
If you’ve written a post for the collective remembrance and don’t see it above, please email the URL to lily@theproviderproject.org, tweet the link to @ProviderProject, or leave it in the comments.
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Posted on 5.31.2012 by Lily
This post is part of our commemorative series here and at the Abortion Gang to honor Dr. George Tiller, who was murdered three years ago today, in a call for collective blog remembrance. If you'd like to submit something, please see this post and link back to it in your own.
On May 31, 2009, I had been a college graduate for one week. I found out about Dr. Tiller’s murder late Sunday night when my boyfriend and I got back from a weekend-long music festival that we’d attended to celebrate graduation. I don’t really remember my reaction, though I’m sure it was of shock and horror. I knew that abortion providers had been killed in the past, but not since I had become politically aware and passionate about reproductive rights.
At that point, I wasn’t sure what I wanted to do with my life, but I did want it to be political and feminist and ideally related to reproductive rights. I was looking for some kind of advocacy job, somewhere like NARAL or Planned Parenthood's Action Center.
A few weeks later, I started training as an abortion counselor. It wasn’t what I really wanted to do, but it was my first job offer and I figured clinic work would be good experience. As they say, the rest is history; now I can’t imagine working anywhere but a clinic. I can’t imagine ever getting the kind of profound gratification from an advocacy job as I get every day from working with patients who need the health services I now help directly provide.
I understand intimately why Dr. Tiller persevered in providing these services through 30+ years of threats on his life.
And many of the patients I work with are women seeking second-trimester abortions. If we were unlucky enough to be in a state with a 20-week ban, my patients would be affected. If they were determined to have an abortion, and we could no longer provide it to them, they would be faced with a daunting prospect: travel out of state, arrange childcare for days, miss work for days, find transportation, potentially conceal their days-long absence from family and/or partner, and raise funds on top of funds to cover it all, besides the funds needed for a late second-trimester procedure. Especially if they have Medicaid, as most of my patients do, which covers abortion in our state but wouldn’t be accepted out of state.
Imagine that the patient is 16. Or lives at 150% below the poverty line. Or is a single mother with three kids. Or has an abusive partner. Or might get fired for missing work, since she’s already been out due to pregnancy-related sickness.
There’s something tragically ironic about having a(nother) baby because you can’t arrange, access, or afford the abortion, isn’t there?
Listen up, pro-choice advocates. It’s past time to stop minimizing late-term abortions, which is what Dr. Tiller was known for and the reason for his murder. Every time we defend abortion rights because “only 1% occur past 20 weeks” we do a disservice to Dr. Tiller's legacy and to the patients who desperately need those abortions. It doesn’t matter if late-term abortions are 1% or 100% of all abortions. They are urgently needed. They are a matter of life and death.
Three years ago, I had just graduated college and finished my year as president of my school’s Students for Choice. After Dr. Tiller’s murder, I wrote a final email to the group’s listserv. I had not yet begun working in abortion care, and I’ve learned an immeasurable amount since about abortion and how this work is love and life and everything good. But you don’t have to work in abortion care to understand the importance of Dr. Tiller’s work and his legacy, and so I’d like to share that (gently edited) email below.
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Posted on 5.21.2012 by Lily
If you haven't seen it yet, yesterday's New York Times editorial summarizes the recent and seemingly endless legislative assaults on women's health and well-being. They divide these attacks into four broad categories of abortion, equal pay, domestic violence, and access to basic preventive health care, showing that the war on women is not imaginary and fetus-loving can't exactly be the motivation for it all. (That last bit may be my own extrapolation.)
Despite the persistent gender gap in opinion polls and mounting criticism of their hostility to women’s rights, Republicans are not backing off their assault on women’s equality and well-being. New laws in some states could mean a death sentence for a pregnant woman who suffers a life-threatening condition. But the attack goes well beyond abortion, into birth control, access to health care, equal pay and domestic violence.
Republicans seem immune to criticism. In an angry speech last month, John Boehner, the House speaker, said claims that his party was damaging the welfare of women were “entirely created” by Democrats. Earlier, the Republican National Committee chairman, Reince Priebus, sneered that any suggestion of a G.O.P. “war on women” was as big a fiction as a “war on caterpillars.”
But just last Wednesday, Mr. Boehner refuted his own argument by ramming through the House a bill that seriously weakens the Violence Against Women Act. [...]
Whether this pattern of disturbing developments constitutes a war on women is a political argument. That women’s rights and health are casualties of Republican policy is indisputable.
Go read it all.
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Posted on 5.15.2012 by Lily
Last month Amy and I went to CLPP, a 3-day reproductive justice conference filled with fabulous, progressive people working in all sorts of social movements. One of the workshops I went to was run by the OCs OTC Working Group, which is a coalition working to make birth control pills available over-the-counter.* This is a tough idea for a lot of people to swallow, including reproductive justice folks. But over-the-counter contraception actually makes a ton of sense.
In the US, hormonal birth control access has traditionally been tied to the annual pelvic exam and Pap smear. Women know that if they wish to prevent pregnancy pharmaceutically, they must jump through the Pap hoop. (How ‘bout that image?) But this connection is a mistake of history. No Pap result contraindicates the use of hormonal birth control; contraindications are found by taking a medical history and checking blood pressure. No exam necessary.
(Lest anyone think I’m saying Paps and well-woman exams are irrelevant, please be assured that I’m fully aware of their importance. Of course everyone needs regular check-ups, and the Pap is the best tool we have to prevent cervical cancer - although many practitioners still don’t follow the updated Pap protocols, which say that most women need a Pap only every 2-3 years rather than annually and no one needs one before age 21, period.)
Nor am I saying that birth control has no place in the doctor’s office. Over-the-counter access should ideally supplement, not replace, consultations with your provider. But providers should not be the gatekeepers between women and these needed medications. Clinicians will often withhold refills until patients come in for their appointments, which definitely affirms who has control over women’s bodies, but accomplishes little else - besides contributing to rates of unintended pregnancies and abortions, naturally. A cardiologist would not deny a patient their blood pressure prescription as punishment for blowing off a follow-up appointment. Birth control is no less important a medication, but it is firmly entrenched in the social and political arena of the War on Women and Our Bodies.
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Posted on 5.02.2012 by Lily
This article came out in December, but I wanted to talk about it as a follow-up to Amy’s post from a few months ago. Amy interviewed the courageously innovative Dr. Deborah Oyer, an abortion provider who has uploaded YouTube videos of herself describing abortion options in hopes of demystifying the information, counteracting the ubiquitous anti-abortion propaganda, and reaching those who may be afraid to actually call a clinic. These videos have received tens of thousands of hits; clearly, Dr. Oyer has figured out something very important about communicating with patients today.
And she’s not the only one. As covered by the Times, many organizations now offer sex ed services online and through text message. Planned Parenthood of the Rocky Mountains runs a text-chat program that allows teens to get text responses to their anonymous questions. Other clinics and programs have found various ways to supplement the traditional classroom models with outreach focused in the main place where teens are already looking for information about sex. This is, for lack of a more eloquent word, awesome - and practically bursting with potential!
We badly need to adopt this 21st century-type thinking in abortion services. I can only imagine how many patients would take advantage of being able to ask their questions while “wrapped in the Internet’s comfy blanket of anonymity,” as Amy put it, (I love that line!) if we allowed them to text or email us. Or what if we posted videos where patients could take a virtual tour of the clinic’s waiting room, lab, counseling space, operating room, and recovery area? How about videos of staff introducing ourselves (as Dr. Oyer has also done), putting a human face on abortion provision and showing patients that we are not such scary monsters after all? What if the website explained the process of making an appointment so timid patients knew exactly what to expect when they picked up the phone? Hell, what if we allowed them to book their appointments online, and gave them all the necessary information right there?
Countless patients have confessed to me the fears that plagued them before they set foot in the clinic. Would we be mean? Would we judge her for x, y, z about her situation? Would the clinic be dirty? Were we a real, licensed medical facility? Would it be an actual doctor performing the procedure? Isn’t abortion so dangerous? Were we going to maim her, cause her to be infertile, give her breast cancer? (No, no, no, yes, yes, no, no, no, and no, for the record.)
It’s no wonder patients can be so freaked out about the clinic experience; many of them have been unfortunate enough to go to a so-called "crisis pregnancy center" first, or they’ve researched abortion online and found only anti-choice propaganda. Patients often express surprise and relief to find out that our staff is non-judgmental, helpful, and compassionate; that abortion is one of the safest medical procedures with minimal risks; and that, in general, the quality of care is very high. Of course every clinic and clinic experience is different, but many patients have told me that their abortion was by far the most positive experience they’d ever had with the health care industry.
All too often, patients navigate the United States health care system never expecting to be treated with compassion and empathy, or to be regarded as a fully integrated human being rather than as a set of body parts and symptoms. (See Kelly’s recent post for more about these all-too-common experiences.) It’s emblematic of the bigger picture of the health care disaster in this country, in which services are fragmented, insurance companies call the shots, patient-centered care is pushed to the back burner, and patients are left to struggle their way through however they can.
Obviously, online services won’t fix all these problems. But I think new media does provide unique opportunities to mitigate thorny access to good health care by allowing patients and young people to expand their health education and health literacy without ever stepping foot into a health care facility. And then, when they do need to go to the doctor, or hospital, or abortion clinic, they may well be better equipped and more empowered to be their own best advocate.
What ideas do you have for reaching patients online or through other types of new media? Can any fellow abortioneers or health care workers who offer online services speak about those experiences?
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Posted on 4.25.2012 by Lily
Well, isn’t this interesting? Wikipedia has asked its users to determine what the sides of the abortion debate should be called, considering such options as “anti-abortion movement vs. abortion-rights movement” and “support for legality of abortion vs. opposition to legality of abortion”. I like the idea of this conversation; it’s long time to do away with the ridiculous notions of “pro-choice” and “pro-life”. (“Pro-life”, of course, is anything but. “Pro-choice” is a simplistic trivialization of the need for abortion, in which the consumerist concept of choice rarely enters the equation.) I would advocate for reproductive justice to become our dominant framework as the issues extend far beyond abortion rights, but alas, the RJ movement has yet to overtake the American public’s love affair with catchy little slogans.
Via.
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Posted on 4.20.2012 by Lily
Confession: I’m a longtime lurker, first-time participant in this world. My feminist identity can be largely attributed to the feminist blogosphere, in all its diversity and glorious controversy; several years ago I even wrote my senior thesis on the topic. But the Provider Project represents my first official foray behind the scenes. So, hello and welcome! Let’s get to know each other a bit.
For the past few years (pretty much since I turned in that thesis) I’ve been working in abortion clinics. I’m trained primarily as a counselor, though I’ve also at various times been a medical assistant, receptionist, and all-around clinic lackey. Abortion work is intense, exhilarating, heart-wrenching, exhausting, and profoundly gratifying. It is what I want to do with my life.
And part of my job, as I see it, is talking about my job. It’s being public about what I do. It’s enlightening people about the reality of abortion and clinics and sexual and reproductive health, because being open is how we fight stigma and shame.
It’s no secret that one in every three women will have at least one abortion in her lifetime, or that over 99% of American women having heterosexual intercourse use contraception at some point. For this hardly insignificant population, abortion and birth control are not theoretical questions of morality and rights to be debated on the floor of Congress. They are real life problems and needs. If only we collectively demanded that our leaders work in favor of our realities!
And that’s what I really want to talk about: reality.
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