Last week, the U.S. House Committee on Energy and Commerce heard three "experts" on abortion policy testify on H.R. 358, the "Protect Life Act," one of several bills before Congress right now aimed at reducing access to legal abortion services. The witness panel included two well-known opponents of women's choice, Helen Alvaré, associate professor of law at George Mason University and Douglas Johnson of the National Right to Life Committee; and Sara Rosenbaum, chair of the health policy department at George Washington University School of Public Health and Health Services. Only Rosenbaum spoke in defense of protecting U.S. women's legal right to abortion.
Alvaré, formerly general counsel for the National Council of Catholic Bishops and self-described "born-again Catholic," said in her testimony that even after 38 years of legal abortion, the United States "is a market that looks like this: 87 percent of U.S. counties with no abortion providers; steadily declining numbers of abortion clinics (which decline began long before clinic prayer vigils and protests began in earnest), largely due to the stigma associated with abortion among physicians and in the medical profession generally...."
Let's not be coy about this stigma; since the Supreme Court handed down its decision in Roe v. Wade in 1973, anti-abortion advocates like Alvaré and Johnson have been working to eliminate abortion in the United States by shaming women and doctors and nurses and their families. Women walking into clinics are taunted. Providers of abortion care are stalked, threatened and assassinated. Even landlords and office suppliers to clinics are harassed. By creating controversy, they created an environment that separates abortion from comprehensive health care for women.
Their strategy was crystal clear in Alvare's testimony: "...abortion has not attained the status of a standard of health care, a message which might well help begin to reverse the negative role played by legalized abortion in the lives of American women, particularly the most vulnerable women."
The effect has been insidious, isolating abortion from the broader range of health services, making it easier to isolate and punish those associated with it. There is no other medical procedure that medical students must ask to learn. Abortion is the only medical procedure singled out in the new health-care law. And it is the only medical procedure to be adjudicated by the Supreme Court. Do medical students have to seek out special training to learn to treat penile dysfunction? No.
There is no excuse for a physician, much less an OB/GYN, not to know how to perform an abortion procedure in the simplest, safest way possible. And yet, ninety-seven percent of U.S. family practice residents and 36 percent of OB/GYN residents have no experience providing first-trimester abortions. According to medical students nation-wide, both infertility and Viagra are covered more frequently than abortion in medical school curricula.
The facts show that the ability to terminate a pregnancy that is unhealthy or unintended is a critical part of women's health: one in three women in the United States will have had an abortion by the time they reach 45. Abortions are needed to save women's lives every day in the United States and around the world.
Abortion stigma, like other types of stigma, is contagious, leading even otherwise stalwart progressive advocates to hesitate in defense of abortion rights. The stigma surrounding abortion is real and it's a prime weapon in the opposition's arsenal; women are demonized for having an abortion and providers for offering comprehensive care.
At Ipas, we see this all over the world. For example, in Zambia, it is believed that women who have had abortions are inflicted with an evil spirit that can be transmitted to anyone who interacts with her.
"...When someone aborts some 'traditional things' will affect you...if you stay with the person you may get sick also...you develop something evil. [Others] will not even eat with that person who has aborted; they will not share a plate or visit that person," said one participant in the Copperbelt Province of Zambia during focus groups Ipas conducted there to assess abortion stigma. The result of such stigma, of course, is that women who have an abortion are socially isolated and shunned from their communities and families in Zambia. How far is the United States from this?
Alvaré and her cohort use stigma to oppress women by creating laws that further stigmatize women and abortion. When we force women to look at unnecessary ultrasounds, we're legislating stigma. When we force girls to track down missing parents in order to get consent to have abortion that is stigma translated into law. When we isolate abortion from comprehensive reproductive health services, we are institutionalizing stigma. And we know from our work in countries where abortion is restricted or banned that adding barriers to abortion does not lower the need for abortions; they only lead to deaths and injuries for women from unsafe abortions.
In the spate of "abortion ban" bills before Congress, this deliberate effort to institutionalize stigma is taken to a new level to ensure that women will be punished for making difficult decisions -- even if they are the best ones for their health, families and future. The government is now creating economic disincentives for abortion; when will we start confining women to their homes? When will we start sending doctors to prison?
At Ipas, we know that stigmatizing abortion is inherently harmful to women's health -- preventing them from getting the care they need. When abortion is inaccessible either legally, financially or physically, women are more likely to turn to the back alley.