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T.R. Reid's Case for an Authentically Pro-Life Case for Healthcare Reform

Tue, 2010-03-16 12:06 — figleaf

Ezra Klein correctly channels T.R. Reid.

“To oppose expanded coverage in the name of restricting abortion gets things exactly backward,” writes T.R. Reid. “It’s like saying you won’t fix the broken furnace in a schoolhouse because you’re against pneumonia.” Here’s his argument:

Read the quote in context here.

In a nutshell Reid says part A would be…

In Britain, only 8 percent of the population is Catholic (compared with 25 percent in the United States). Abortion there is legal. Abortion is free. And yet British women have fewer abortions than Americans do. I asked Cardinal Hume why that is.

The cardinal said that there were several reasons but that one important explanation was Britain’s universal health-care system. “If that frightened, unemployed 19-year-old knows that she and her child will have access to medical care whenever it’s needed,” Hume explained, “she’s more likely to carry the baby to term. Isn’t it obvious?”

A legitimately life-affirmative position that, for instance, the Nebraska Right to Life PAC appears to also endorse. (If one was actually “pro-life” as opposed to merely anti-sex or anti-women’s-autonomy, supporting women who choose to keep an unplanned pregnancy… as opposed to, say, relishing pregnancy in particular and children in general as women’s ordained punishment for “original sin.”)

Reid’s Part B goes like this

A young woman I knew in Britain added another explanation. “If you’re [sexually] active,” she said, “the way to avoid abortion is to avoid pregnancy. Most of us do that with an IUD or a diaphragm. It means going to the doctor. But that’s easy here, because anybody can go to the doctor free.”

Another excellent point, obviously.

If one really wanted to reduce abortion, as opposed to, say, using the threat of pregnancy to hammer women into submission, one would enthusiastically embrace both parts A and B, and one would tend to view extending coverage to the most economically vulnerable population as an excellent step in the right direction. If one actually didn’t give a flying fig about abortion except as a way to enforce, say, Rule of Desire #1 you’d expect them to oppose healthcare reform.

Matt Yglesias on Mistaken Thinking About Preventable Deaths

Mon, 2010-01-11 21:58 — figleaf

Matthew Yglesias thinks instructively about why people imagine some kinds of preventable deaths are more important than others.

It’s quite true that human beings do not have a great intuitive grasp of statistical arguments or a great love for them. But the world would be a better place if people thought of these things in a more statistically informed way. Likewise it’s true as Jon Chait says that people generally think differently about intentional murders than thinks like car crashes. But this, though it’s definitely a fact of life, is also a problem that it would be good to ameliorate over the long run. People tend to view threats stemming from identifiable, individual villains as more problematic than impersonal ones. But while this is a fact of life, it’s also a mistake. If we do something to very slightly reduce the risk of a terrorist attack that has the inadvertent consequence of causing a large number of additional highway deaths then that would be a mistake.

Read the quote in context here.

I’m… fairly confident many of the same principle applies to matters of sex, choice, reproduction and contraception, agency and autonomy, etc. Opposition to hormonal contraception, for instance, not because of the small but real risk of embolism or thrombosis in the woman who takes it but instead an infinitesimal-to-the-point-of-imagination risk that ovulation and fertilization of a hypothetical “life” might somehow magically occur… and yet somehow not implant. To name one. To name another, fanatic willingness to murder healthcare providers in church over abortion but absolute zero, nothing, none interest, at all, in parting a hair to prevent about approximately equal numbers of miscarriages (environmental- or stress-induced or otherwise)... or to do anything at all about stillbirths, infant or maternal mortality, or prevention of childhood deaths from, say, asthma.

But again it’s a general principle. Although expand the scope just a teeny tiny bit and you’re left wondering about the “moral” hesitation in the early 1980s that allowed HIV to become a global epidemic instead of a relatively isolated outbreak, where squeamishness about thousands of “h-word” people (hemophiliacs, heroine users, and homosexuals) mainly in the U.S. allowed it to spread to tens of millions of “pa-word” people (pretty-much anybody.)

Cute Backup Your Birth Control Promo: "If You Can Accidentally Text Your Grandmother On New Years Eve What Else Can Go Wrong?"

Wed, 2009-12-30 01:19 — figleaf

You know how there’s that sort of informal recommendation that you replace your smoke-alarm batteries twice a year when daylight-savings time changes? Vanessa of Feministing says there’s a similar movement afoot around backing up your birth control after New Years Eve.

[E]mergency contraception sales more than double the days after New Year’s Eve. It’s good to see someone addressing that; this comes from a new project of the Back Up Your Birth Control Campaign.

Read the quote in context, and find a link to a can’t-help-but-giggle video, here.

To be honest you probably don’t need to replace modern smoke-alarm batteries every six months, though you should check at least twice a year to make sure they work correctly. And to be honest the day after New Years Eve might not be the best time to backup your birth control, as for at least some people the message instead might be to restock. But for those with a serious prospect of partnerships that could result in an unplanned, unwanted pregnancy it’s just as important to keep your emergency (and regular!) contraception up to date as it to make sure your smoke alarms are in working order.

_In case I forget, remind me to add

Ever Wonder How Contraception Became Such a Toxic Issue in Congress In the First Place?

Sat, 2009-11-14 09:49 — figleaf

Lynn Gazis-Sax of Noli Irritare Leones asks how birth control came to be left out of most healthcare legislation.

Sharon Lerner at DoubleX ponders how birth control came to be a politically toxic issue.

...

On the one hand, I can understand why birth control wasn’t included in the minimum benefits package. When you’re making a big change, and not including birth control simply leaves the status quo (rather than actively making the status quo worse), it’s easy to run from the least whiff of controversy, just to keep your bill intact. On the other hand, it’s discouraging that birth control, of all things, which practically everyone uses, should be controversial.

Read the quote in context here.

Actually I can say exactly how contraception became toxic in Congress so long ago. It’s actually the issue that first inspired me to start a website back when I thought I could become a regular political web-logger back in the days before actual blogging tools. That old website is now so long-gone I can’t even find the (hand-coded) source files.

Anyway, while I evidently no longer even have notes for my sources I learned the answer in an old print-based Washington Monthly from back in what must have been the early 1990s. What they said was that beginning in the 1970s pressure politics was such that no conservative Republican Senators would allow any legislation referencing birth control to move forward if it included support for abortion. No liberal Democratic Senator would support anything that didn’t include support for abortion. And no matter who brought it up or how reasonable the proposal was it always turned into a fight that would often spill over into other bills, with pro-choice attachments showing up here and anti-choice attachments showing up there and, since passions ran quite high, no possibility of resolution.

The result was a cordial agreement on both sides not to even bring it up. By the time the Monthly published the story the agreement was already nearly 20 years old. It would have been more than 30 years ago now.

What was particularly disgraceful was that at the time contraception itself wasn’t particularly controversial. Not for liberals, obviously, but also not for non-Catholic, pre-Reagan-revolution conservatives. And so absent the abortion issue what little legislation that did make it through tended to pass by overwhelming majorities in both parties.

Warn’t them the days though? Bipartisanship sure was great back then.

Consumer Reports: Doing it Since Before it Was Cool

Fri, 2009-11-13 13:32 — figleaf

Just a tip of the hat to Consumer’s Union, the publishers of Consumer Reports. Like a number of other folks who blog about relationships and sex I got advance notice that CR will have a review of condoms in their November issue.

I should say they’ll have another review. Which they’ve been doing on and off for years. Going back to the days when condoms weren’t just controversial but weren’t cool either. Or particularly safe or reliable. They got a lot of heat for it then. I had very personal reasons to be grateful then, though. And we all have good reason to be grateful now.

Not least because straight-up, no-nonsense, business-as-usual reviews that forswore the standard knee-squeezing and tittering and asked fundamental questions actual consumers wanted to know. Questions like do they work? Do they leak? Are they durable? Are they affordable? And are those stupid glow-in-the-dark kinds anything but a risky stunt?

The short answer, by the way is an overall yes, while some are less reliable than others condoms made today are safe and effective if used properly!!! Which is more than you could say years ago.

Good for them.

Quick note: for those of us familiar with ad-revenue-driven sites, and venture-capital-financed sites it’s a bit irksome that Consumer Reports puts its reports behind a for-pay firewall. However unlike pretty much all aforementioned sites Consumers Union accepts no advertising, accepts no venture financing and, as far as I know, accepts no other kind of grants or funding that would compromise either their mission or their integrity. For that reason you’ll have to pay to see their condom reviews online, or find the magazine on the shelf of a store or library. But you know what? In this case you really do get what you pay for, and, in this case I think that’s worth a lot.

They do have a blog, though, and like all good blogs it’s free. Here’s their post on their condom article.

Seven of the 20 models we tested earned a perfect score, indicating they were not only stronger and more reliable than most, but also had no leaks or flaws in their packaging. Those top seven include one Durex, two Lifestyles, and four Trojan models (Ratings available to subscribers). Alas, one of the more playful condoms we tested, the Night Light glow-in-the-dark model, didn’t fare as well, earning our lowest score for strength and exceeding the allowable number of samples with holes. But it did live up to its name on the glow front.

Read all about it here.

I gotta say I love that they confirmed that, as advertised, at least the glow-in-the-dark condom actually glows in the dark.

Contraception as Supply and Demand Problem

Fri, 2009-09-25 22:06 — figleaf

Aah, nice to be back in WiFi range.

Matthew Yglesias does a great job of distinguishing between what I think might be a right-wing bugaboo — forcing population control — and helping individuals plan to have the size of family they actually want. It’s in the context of a claim that the carbon-reduction benefit of contraception is cost effective compared to other, perhaps more obvious reasons. But the “eugenics” vs. consumer demand argument stands regardless. Here’s Yglesias (emphasis mine.)

Lydia DePillis has a depressing item about the role access to contraceptives is playing (or, rather, not playing) in efforts to forestall catastrophic climate change

... Reducing the number of unwanted pregnancies out there—calculated on the basis of “unmet need,” or women who want contraception but currently don’t have access — is roughly five times as cost-effective as deploying low-carbon technologies like wind, solar, and carbon sequestration.

... That’s not to say we should be engaging in coercive limits on people’s ability to have children, that would be a cure that’s far worse than the disease. But the evidence is pretty clear that in societies where women are empowered and have access to contraception, that on average they want modest-sized families. And what this study is talking about is specifically what could be accomplished by closing the gap between the level of contraception that people want to have and the level of contraception they’re actually able to maintain. There are dozens of good reasons to think closing that gap would be beneficial, the impact on the environment is one of them, and there’s no reason people should refuse to say that.

Read the quote in context here.

This ought to hold true, by the way, even if you’re opposed to abortion. It ought to hold true even if you (mistakenly) believe certain forms of contraception are really secret, closet forms of abortion, because if you really believe that then you’re obliged only to advocate for contraceptives you can’t possibly pretend cause secret, closet abortions.

(That we don’t see contraceptive opponents pressing for safe, effective, affordable, reliable, available, and usable methods that satisfy their concerns about “abortion” suggests they’re insincere. And, to borrow the phrase from Yglesias, there’s no reason people should refuse to say that either.)

Gubernatorial Candidate Bob McDonnell, Slow Learner

Wed, 2009-09-09 11:42 — figleaf

Latoya Peterson of Jezebel linked to a Washington Post article on Virginia gubernatorial wannabe Bob McDonnell’s “turnaround” from his not-all-that-long-ago total-wingnut thesis for a combined masters in public policy and JD in law at Pat Robertson’s Regent University titled “The Republican Party’s Vision for the Family: The Compelling Issue of The Decade” wherein he opined that feminism was deviant, that the law should discriminate in favor of married couples, that women shouldn’t work outside the home, and in particular that childcare assistance should be illegal to help force women to stay home. In other words he was a huge jerk. And based on his legislative and activist history since he still is.

But as Peterson notes the world’s changed even for McDonnell.

Then McDonnell tries to play the “I can’t be sexist, I have a wife and a daughter” card. Through a statement, McDonnell explains:

[H]e is “fully supportive of the tremendous contributions women make in the workplace. My wife and daughters work. My campaign manager in 2005 was a working mother. I appointed 5 women to my senior staff as Attorney General.”

Read the quote in context here.

On the one hand good for him for hiring women. Amazing how tremendous a contribution they’re able to make once major social and legal obstacles are removed, eh? On the other hand, based on his politics is there any reason to believe he’d still have appointed five women to his senior staff if it hadn’t been politically unpopular and, oh, say, illegal to discriminate against women in hiring decisions? And what’s his voting record been in the last 20 years that would lead one to believe he’d support women in the workforce if anti-discrimination laws were just now percolating up through the legislature?

My guess would be no. But times change. He’s now a jerk who thinks women should be able to work but not have reproductive self-determination. That’s progress. In another 20 years he may notice that dismantling the rest of the… (um… what’s the opposite of a “social safety net?”)... social obstacle course won’t bring about the end of the world as we know it either. But call this another instance where “slow but steady” probably shouldn’t win the race. At least not this one.

Em Dee IOU: Women in Healthcare Professions Roughly Twice as Likely to Use IUDs as General Population

Sat, 2009-08-01 13:19 — figleaf

Here’s an interesting link on the heels of yesterday’s post about IUDs. Ema of The Well-Timed Period points to an article in the international (and pay-walled off from real people like us) journal Contraception.

Your Ob/Gyn is probably using an IUD. So, why aren’t you? And for all you physicians out there, don’t be an IUD nonplacer [my new favorite word].

From a survey of female employees at a Midwestern University, among heterosexually active, premenopausal nonsterilized respondents (n=4764):

  • Ob/Gyns reported greater history of IUD use than all others (34% vs. 12%).
  • Physicians overall reported greater IUD use than nonphysicians (24% vs. 12%).
  • Clinicians who place IUDs reported more personal IUD use than nonplacers (33% vs. 18%).
  • Among women who intend future pregnancy, 26% of Ob/Gyns reported history of IUD use versus 17% of other physicians and 6% of nonclinician Ph.D.s.
  • 17%, 12% and 4% respectively reported current IUD use and future childbearing intention.

Read the quote in context here.

This should not be taken as “well if doctors are doing it it must be true.” Just because women in the broader field of reproductive health use IUDs more often than comparable women in other fields doesn’t mean it’s everyone’s best choice. For instance even if 34% (or is it 26%) of women Ob/Gyns use them the rest sort of don’t. But still, 34% (or maybe 26%) of Ob/Gyns is a heck of a lot more than 12% (or maybe 6%) of the general population.

Without actually knowing why the ratios would be higher I can think of three possibilities.

  • Women in reproductive health have more overall exposure to positive and/or current research-based, clinical, and anecdotal information about IUD use. And/or for the same reasons more familiar with complications of other forms of contraception (including side effects, yes, but also failures.)
  • Women in reproductive health might tend to be slightly older and more likely to have been pregnant and thus more likely to be good candidates for IUDs.
  • Women in reproductive health, including especially Ob/Gyns and physicians, may have enough financial and transportational access to healthcare that they can afford the up-front cost and that they can also have more confidence that should they encounter complications they would be able to afford/receive any follow-up care that might be needed, including removal. (Note: I think this may be one of the bigger factors.)
  • Since if an IUD works well you can leave it in for up to a decade (the non-hormone- or copper-coated ones anyway) and since if you’ve got one discontinuing use involves another doctor visit then over time there’s likely to be a larger “default” pool to answer yes on surveys.

Or, since the study was large (4,000+ women) but all employees of a single university…

  • It could just be that the healthcare system at that one university might be particularly effective at encouraging IUD use or else particularly effective when it comes to training clinicians how to insert them. (In comments to my previous post Kaija says proper training isn’t common but makes a big difference in patient satisfaction.)

I’m guessing the answer is “some or all of the above.” But I’m guessing access to current information, affordability, and caregiver training are all big factors.

—-

Finally, I always feel a little weird being enthusiastic about IUDs as contraception. It’s just that as far as long-term cost and complication rates (including failure) they’re a very good choice. I’ve already always been an advocate for male vasectomies, and informed and optimistic about their reversibility. And, trust me, if there was any other reliable, reversible “set it and forget it” contraceptive for men, the way IUDs are for women, I’d be all over that instead. And while researchers are always promising promising new technologies, in practice there are still only three forms of male contraception: vasectomies (invented 200 years ago) condoms (invented at least 500 years ago) and withdrawal (much mocked and “invented” at least as far back as the Old Testament.)

Hey You IUD! Plus Possible Benefits of Decoupling Pregnancy and STI Concerns

Thu, 2009-07-30 18:57 — figleaf

Megan Carpentier of Jezebel says

Slate’s Kate Klonick wonders why more American women don’t use IUDs. As the recipient of one of the devices as well, I sometimes wonder the same thing.

She said it here.

Carpentier’s a good writer. IUDs are amazingly effective but pretty misunderstood. She does a great job laying out the many pros, laying out the few cons, and laying to rest some of the seriously out of date and never all that true myths about them. I’d say go read it even if you’re not in the market for a different, highly-effective, low-maintenance form of birth control. Because you might know someone who is.

—-

By the way, is it just me or does it seem like the standard “yeah but” objection about how you still need to use condoms to prevent STIs comes up sooner in discussions of IUDs? I mean, yeah, duh, but it’s just as true of every other non-condom form of contraception from the Pill to sponges to vasectomies to… oops… “abstinence-only” activities like oral and anal contact. But why let that be an objection at all? Not to sound too pundit-y but pregnancy and STIs are two different issues both in theory and practice: not everyone who needs to worry about STIs needs to worry about pregnancy, and not everyone who needs to worry about pregnancy needs to worry about STIs. And, again not to sound too pundity-y but STIs can be transmitted a lot more ways than pregnancy can. And not to sound too contrarian but very high-reliability contraceptive measures like sterilization and IUDs might make it easier for heterosexuals to pay closer attention to avoiding giving each other STIs.

Upate: About that STI link: In comments here Sugarmag explains that possibly dated information associates IUDs with greater chances of STI-derived pelvic inflammatory disease. But further down in comments here Kaija says more recent research says STI-related complications seem to come mostly from pre-existing STIs rather than infections transmitted after the IUD is in place.

[Note: 24 hours later I realize the title sounds awfully insistent. My titles are often a bit goofy or free-associative — possibly because I do them last thing after I’ve written the post. In this case I was thinking about the subject matter and the English vowel sounds, AEIOU, kept coming up, and then AE-IUD, then Hey Hee-IUD, and then Hey You IUD. So it was totally random but, I realize now, it sounds awfully bossy too. If it’s just me then forget about it, if it bugged you too then my apologies. —fl]

Gaining Ground With "Common Ground" Initiatives

Thu, 2009-07-16 14:12 — figleaf

Amie Newman of RHRealityCheck.org is the latest to bring up one of the latest dividends of the pro-choice “common ground” initiative that tries to find, well, common ground with people who are leery, squishy, or squicked by abortion.

From Feministing:

U.S. Rep. Tim Ryan (D-OH) was removed from the Democrats For Life of America’s advisory board because he supports contraception.

Apparently, DFA was tired of Ryan consistently harping on this crazy idea that the way to prevent unintended pregnancy is by ensuring access to contraception:

“DFLA gave Congressman Ryan ample opportunities to prove he’s committed to protecting life, but he has turned his back on the community at every turn,” said Kristen Day, the Washington, D.C.-based pro-life organization’s executive director.

What does “ample opportunities to prove he’s committed to protecting life” mean to DFLA? It seems clear that “protecting life” is not about preventing unplanned pregnancy and abortion. According to Ryan, 

“We’re working in Congress with groups that agree with preventative options while [the DFLA] is getting left behind,” Ryan said. “I can’t figure out for the life of me how to stop pregnancies without contraception. Don’t be mad at me for wanting to solve the problem.”

...

I think [Ryan’s] removal [from the DFLA board] has the potential to shine a very real light on how extremist many of the anti-choice organizations are. In this case, we now have a legislator who says clearly that he is working in Congress with various groups that can agree that access to contraception is critical. This work will continue with Rep. Ryan while DFA and others insist on sacrificing what most Americans want and need in regards to their sexual and reproductive health, pledging allegiance to rhetoric instead.

Read her post, and untangle my quotes within quotes, here.

And just to keep the flying links confusing, here’s a comment I left on a similar post by Jill Filipovic on the same topic at Feministe.

This sort of thing is the biggest dividend of the “common ground” initiative: it drives a huge wedge between the majority of people who just wish there weren’t as many abortions from… the kind of people who want to use abortion to control (heterosexual?) sexual behavior.

And the thing is it’s not just a wedge issue: I don’t know about Rep. Ryan himself but plenty of people like him really are comfortable with increased support for contraception (which includes making it safer, more effective, easier to use, less expensive, more accessible, and more widely available.) And most are willing to let abortions (however uncomfortable it makes them) as long as they think progress is possible in reducing unwanted, unplanned pregnancies in the first place.

Is that sort of pragmatic “common ground” ideal? No. What would be ideal would be unreserved and unconditional support for women’s reproductive self-determination. But in terms of coalition building it’s far, far better to have them on our side than on the anti-choice side. And just making the “common ground” effort, as we see, works two ways. First, it makes us appear sympathetic to waverers. Second, it drags real hard-core anti-choicers like the DFLA, the Southern Baptist Convention, and the U.S. Congress of Bishops into sunlight… where even to erstwhile allies like Rep. Ryan or even, say, shell-shocked-by-conservatism’s Will Saletan, their creepiness is impossible to miss.

So yeah, no way we’ll ever get to common ground with the DFLA. But then we don’t have to. Creating opportunities for them to alienate their nominal supporters is enough. Because, seriously, do you think they’d have kicked Ryan out if someone else hadn’t reached out to him? No.

Three and a half years ago people were telling me no way. But the result that I was looking for back then is slowly percolating into existence.

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