Komen and Planned Parenthood: The politics of abortion meet the politics of breast cancer

As of this posting it appears that Komen has restored its funding for Planned Parenthood. I thought I would run this post anyway. I think it makes some important points.

As reported in the New York Times on February 1, 2012, “Cancer group halts financing to Planned Parenthood”, the Susan G. Komen Foundation will abruptly end a program that gave about $700,000 to 19 Planned Parenthood (PP) affiliates to fund breast mammograms and ultrasounds for women who cannot afford them. Just to be clear, the Komen Foundation, the world’s largest breast cancer foundation which is famous for its pink ribbons and “Run for the Cure” races, has not changed its position on screening for breast cancer. It just doesn’t want to fund this screeining through Planned Parenthood, which will present a problem for the three-quarters of a million women who have had their mammograms through that organization.

Why? There has been a very long standing relationship between these two organizations committed to women’s health, and this decision seems to be very sudden. According to the Times, “A spokeswoman for the Komen foundation, Leslie Aun, told The Associated Press that the main factor in the decision was a new rule adopted by Komen that prohibits grants to organizations being investigated by local, state or federal authorities. Ms. Aun told The A.P. that Planned Parenthood was therefore disqualified from financing because of an inquiry being conducted by Representative Cliff Stearns, Republican of Florida, who is looking at how Planned Parenthood spends and reports its money.”

On the face of it, this is absurd; any state legislator can do an investigation into any organization for any reason, and they do. Unlike investigations by law enforcement bodies, in which presumably there is at least a reasonable suspicion of illegal activity. It can only be inferred that this “new rule” was specifically instituted to remove funding for PP. And Komen didn’t have to wait for Rep. Stearns; my state of Kansas has been regularly investigating our Planned Parenthood, starting under former Attorney General Phill Kline, who illegally kept subpoenaed records after he left office. When it finally went to trial after several years, the case was decided by a jury in less than 30 minutes, for PP. More recently, the current administration (also, coincidentally, Republican) has tried promulgating new health department rules regulating abortion providers that were absurdly picky, such as the size of janitorial closets. This has also been discarded.

Wait, Planned Parenthood does abortions? Could that be part of the reason? Why yes. Some, but not all, PP affiliates perform abortions. PP provides comprehensive women’s health services, including contraception and education, as well as breast cancer screening. The Times article notes that many have suggested that it is pressure from right-wing anti-abortion groups that has caused this action. For example, “…in December, LifeWay Christian Resources, which is owned by the Southern Baptist Convention, said it was recalling a pink Bible it was selling at Walmart and other stores because a dollar per copy was going to the Komen foundation and the foundation supported Planned Parenthood.” Of course, this is not really a different reason; the reason that Rep. Stearns and AG Kline and others have for investigating PP is because they do abortions.

In further “explanation” (since the original one was so nonsensical), the Komen “…foundation issued a statement saying it was seeking to ‘strengthen our grants program’ and had ‘implemented more stringent eligibility and performance criteria….While it is regrettable when changes in priorities and policies affect any of our grantees, such as a longstanding partner like Planned Parenthood, we must continue to evolve to best meet the needs of the women we serve and most fully advance our mission.” I had to include this last sentence so that I can recommend that you copy it and save it for a time when you need a piece of corporate double-speak jargon that says nothing except “We’re lying here.”

Planned Parenthood affiliates who do offer abortion services see them as part of the continuum of women’s health care. They offer sex education and contraception, but sometimes this fails – or hasn’t been used -- and women seek an abortion, which may be their first contact with PP. And they may then avail themselves of PP’s other services so they do not have another unwanted pregnancy.  Of course, there are many people who are opposed to abortion who support these other missions (contraception and sex education, as well as breast cancer screening). Therefore, PP usually segregates its funds so that only donations that are unrestricted or specifically intended to support abortion services are used for that purpose. However, there are many others, particularly organized “right-to-life” groups, who are not only opposed to abortion, but to the other missions as well.

A rational, data-driven approach would note that the only things that have ever been shown to reduce the abortion rate are comprehensive sex education and easy availability of contraception. This is why the abortion rate in many countries where abortion is legal is lower than in others where it is not – because those same countries provide sex education and contraception. And, of course, they also provide safe abortions so that the women who receive them are much less likely to develop infections, become sterile, or die.

The only way to understand the opposition to contraception and sex education is to recognize that it is really about being opposed to sex. If you hold the view that sex should only occur in marriage, and then only for the purpose of procreation (thus, only heterosexual marriage), and should not be for fun (and maybe should not ever be fun) this starts to make sense. In a bizarre way. Of course, this excepts the many religious and anti-abortion leaders who are involved in active and extramarital sex. They seem to have no problem telling women what to do with their lives, while living their own lives in total hypocrisy. Of course, but these are mostly men, so what do you expect? They don’t get pregnant.

In another big news item in the same issue of the Times, we are informed that rates of second surgery after lumpectomy for breast cancer vary widely by surgeon, from 0% - 70%. (Breast Cancer Surgery Rules Are Called Unclear by Denise Grady reports on Variability in Reexcision Following Breast Conservation Surgery by Lawrence McCahill and colleagues, published in JAMA, February 1, 2012. In doing lumpectomy for breast cancer, there is a cosmetic reason for taking only the least amount of tissue necessary to remove all the cancer. After all, this is the reason that lumpectomy was developed to replace mastectomy. Sometimes, on pathological examination, the “margins” are not “clear”; that is, cancer cells are found microscopically up to or past the border of the excision, and an additional surgery is required to get the rest. The question is whether there are surgeons who regularly seem to do this more often, that is take too little tissue, rather than random variation; the answer seems to be “yes”.

However, the study shows that there seem to be many more surgeons who often do a second surgery even though the margins are clear than there are surgeons who regularly take too little and need to repeat the surgery. This also means that many surgeons who have the former practice may often take too much tissue the first time to avoid the repeat surgery. This is because they believe that there need to be larger margins of normal tissue, of 2-5mm, between the cancer the edge of the excision. Comments by McCahill and other expert breast surgeons indicate that there is no data showing the larger margins provide any lower rate of recurrence than smaller ones.

What is clear, however, is that cancers found earlier and smaller are more likely to require less invasive surgery and have a greater chance of recovery. While the age of starting and the frequency of screening may be controversial (see my perspective on October 30, 2010, Breast cancer screening: conflicting evidence? what are the important questions for health?), it is hard to argue that having making it more difficult to obtain that screening for 750,000 women who use Planned Parenthood is good policy if your goal is to identify and treat breast cancer as early as possible.

Which, of course, is supposed to be the Komen Foundation’s mission.

 The “Lede” story on the Komen Foundation’s reversal, Cancer Group Backs Down on Cutting Off Planned Parenthood quotes Komen’s Twitter post (@komenforthecure): “We want to apologize for recent decisions that cast doubt upon our commitment to our mission of saving women’s lives.”

And for thinking that they could just do this and not ignite a firestorm of protest. Good to see some life in the reproductive rights movement! The anti-abortion-people-who-talk-only-to-themselves-so-much-they-think-everyone-agrees-with-them were unsuccessful in this attempt. Hopefully the women’s health and pro-choice community can remember that these rights are not guaranteed by anything but the willingness of the people to fight for them.

Unintended pregnancy and health disparities

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In "Health in All" policies to eliminate health disparities are a real answer, August 18, 2011, I discussed the work of Steven Woolf, MD, as it relates to health disparities. The major point of that piece is that the health and mortality differences between groups, particularly racial groups, in the United States accounts for an enormous number of excess deaths. If that gap were closed, and everyone in the US had the same age-adjusted death rate as whites, the number of lives saved would far exceed those saved by all medical care. Indeed, it would far exceed the number of lives saved even by public health interventions, at least as narrowly construed. Many of the social interventions that Woolf and colleagues indicate would be necessary to decrease disparities could be thought of as “public health” in a broader sense, because they would improve the public’s health, but in general eliminating poverty and raising educational levels are not part of the narrower public health construct.

In “Unintended pregnancy in the United States: incidence and disparities, 2006”, published on-line-before-print in Contraception, Lawrence B. Finer and Mia R. Zolna of the Guttmacher Institute report on the disparities in a particular group, women of reproductive age, in relation to unintended pregnancy. They combined data from several sources, “…on women's pregnancy intentions from the 2006–2008 and 2002 National Survey of Family Growth… a 2008 national survey of abortion patients and data on births from the National Center for Health Statistics, induced abortions from a national abortion provider census, miscarriages estimated from the National Survey of Family Growth and population data from the US  Census Bureau,” to assess rates of unintended pregnancy and disparities between groups, and compared  this data to rates in 2001.

 They found that the percent of unintended pregnancies remained high, with a slight increase (from 48% to 49% of all pregnancies) from 2001 to 2006. The actual rate increased from 50 to 52 unintended pregnancies for every 1000 women aged 15-44. There was a significant decrease in the rate of unintended pregnancies in women 15-17 years old, but this group still had the highest rates (79%, down from 89%). While the fact that an increased percentage of pregnancies in such young women were intended is not necessarily a good thing, the overall pregnancy rate per 1000 decreased from 47 to 42 in this group. The rates of unintended pregnancy went down with age, but all other age groups had an increase in their rates from 2001-2006, the largest in women 18-24. To say this again: the rates of unintended pregnancy went up in each age group except 15-17, but that group still had the highest rate, with rates decreased in each older age group.

The most important finding was the disparity in the rate of unintended pregnancy by characteristics other than age: by race/ethnicity, by income, and by educational level. The unintended pregnancy rate for women with less than a HS diploma (80 per 1000) was more than 2.5 times that of college graduates (30); the rates for women who were HS grads and those with “some college” were in between. The rate for Black women (91) and Hispanic women (82) was also 2-3 times that of white non-Hispanic women (36). Income, perhaps, had the greatest disparity: the rate for women at <100% of poverty (132) was more than 5 times the rate for women >200% of poverty (24).

OK. This is a lot of data, and maybe it is hard to follow. But the main point is simple: these are staggering differences, and they are difference based upon the same social factors that Woolf and his colleagues address. The magnitude of these differences overwhelms all the other factors that affect this rate. The women whose resources make them least able to economically provide for unplanned children are most at risk of having them.

The percent of unintended pregnancies ending in abortion also decreased, from 47% to 43%, with the greatest decrease (from 47% to 41%) in women 20-24, but rather than being a positive, this decrease is much more likely to reflect the decreased availability of abortion services than a shift in attitudes toward abortion. That is, a larger number of children are being born as a result of unintended pregnancy to families that will have difficulty caring for them. In addition, these families are getting less and less aid from public sources because the same folks who are against abortion and the protection of the “unborn” are also against social services that will help the families of the born.

This study was also the basis for the excellernt column “Failing Forward” by Charles Blow in the NY Times on August 27, 2011.  He makes these points very strongly, commenting on the policies that restrict access to abortion while effectively punishing the children:

“This is what we’re saying: actions have consequences. If you didn’t want a child, you shouldn’t have had sex. You must be punished by becoming a parent even if you know that you are not willing or able to be one. This is insane.”

As in all of Blow’s columns, he includes a telling graphic, here showing the “States of Child Hunger”, the rate and raw number of children in food-insecure households. There are over 17 million hungry children in the US, or 23.2% of all children. The highest rate is in DC, the lowest in North Dakota. After DC (32.3%), perhaps surprisingly, is Oregon (29.2%). However, after that, unsurprisingly, come the usual suspects , many of the states most commonly associated with poor social supports and frequently conservative Republican leadership: Arizona, Arkansas, Texas, Georgia, Mississippi, Nevada, South Carolina, Florida. Most of the New England states are clustered near the bottom (good) end of the list.

The whole thing is not good. Too many poor and hungry children, too little education, too little opportunity for too many women and their families. Too many people and families caught in the multiple challenges of poverty, poor education, and racial/ethnic minority status, all of which are independently associated with health disparities, and which are synergistic in their effect when found together. This is not a society to be proud of. This is a society that needs great change, and it is the change perhaps we’d hoped for with the election of President Obama.

Frequently, the comic strips (not even the overtly “political cartoons”) capture it best. Here is a link to a “Non Sequitur”, by Wiley Miller. Check out September 4, 2001, with the adventures of super “hero” “CongressMan”. Laugh. And then cry.

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Oil Slicks and Abortion: Who do we regulate?

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As the nation grapples with the “Deep Horizon” blowout, which will be uncontrovertibly a complete disaster for the Gulf of Mexico and life within it as well as for the people who live along the Gulf Coast and their way of life, a number of things have become apparent. Some of them are detailed in “Don’t Get Mad, Mr. President. Get Even”, the Sunday, June 6, 2010 New York Times column by Frank Rich. Rich, whose primary theme is the response of the President, details the incredible panoply of disasters and near-disasters caused by British Petroleum, and its apparently complete disregard for the few regulations it has been subject to. He is clearly amazed and disappointed that the President continues to place faith in experts, even those at BP, who had an

“…atrocious record prior to this catastrophe. In the last three years, according to the Center for Public Integrity, BP accounted for ‘97 percent of all flagrant violations found in the refining industry by government safety inspectors’ — including 760 citations for ‘egregious, willful’ violations (compared with only eight at the two oil companies that tied for second place). Hayward’s [BP CEO Tony Hayward] predecessor at BP, ousted in a sex-and-blackmail scandal in 2007, had placed cost-cutting (and ever more obscene profits) over safety, culminating in the BP Texas City refinery explosion that killed 15 and injured 170 in 2005. Last October The Times uncovered documents revealing that BP had still failed to address hundreds of safety hazards at that refinery in the four years after the explosion, prompting the largest fine in the history of the Occupational Safety and Health Administration. (The fine, $87 million, was no doubt regarded as petty cash by a company whose profit reached nearly $17 billion last year.)”

Just to restate: BP had 97% of all flagrant violations. Of “egregious, willful” violations – that is, “we ignored the rules on purpose, not by accident” – they had 760, while oil company offender #2 had 8. Clearly then, in an industry known for arrogance, and for preferring to wield political influence (see: George Bush, Dick Cheney) to actually being careful with our world and our environment, BP stands out. It, corporately (and, probably, individually in its leadership ranks) is the true slick scum, from which the oil slick scum washing up on Louisiana owes its paternity.

So let’s talk about Louisiana. It has a long, well-deserved, reputation as one of our more politically corrupt states. It is the home, most famously until this blowout, of the city of New Orleans that, you may remember, was the victim of Hurricane Katrina in 2005, a disaster that the city has nowhere near recovered from despite its absence from the front pages. The incompetence involved in not maintaining the levees that protected the city, especially its poorest parts, and not planning for what was obviously an event that was going to happen, was only eclipsed by the incompetence of the governmental response. The federal government’s terrible response (see: George Bush, Dick Cheney, FEMA director Michael “Brownie” Brown) has gotten most of the criticism, deservedly so, but the response of the state of Louisiana, under Governor Kathleen Blanco, was at least as incompetent – and it was their home state. Of course, in many ways, government in Louisiana has had some of the characteristics of that in nearby places such as Haiti – close collaboration with the wealthy minority that exploit its resources for their personal gain, and, of course, that of the politicians that they pay. It has frequently led to enough anger that populist, if scarcely reformist, politicians have been elected by regular people angry at this exploitation. They too, we well know, have been bought (see: Long, any first name).

The lack of regulation by the state government, in fact its coziness with, the oil industry has been a characteristic of Louisiana. The benefits are jobs for its citizens who work in the oil and gas industry that is so important to the state’s economy (and of course to the politicians who receive “contributions” if not outright graft). The risks are to those same workers, who, like their brethren in the coal industry, are periodically subjected to accidents leading to maiming and death, or, if they are lucky enough not to be sudden death victims, to long term health consequences from their occupational exposures. These industries need to be tightly regulated and controlled, and they can be. As in the case of Haiti (in the 19th century), and much of Africa, and other places rich in natural resources, the large corporations need them. The natural resources – oil and gas, or coal, or diamonds and goal, or tungsten and bauxite and copper – exist where they exist and the corporations need them, and despite their bluster will make the investment in safety, for the people and the environment, if they are absolutely forced to, not just by law but by enforcement.

And then there are oil rig blowouts polluting the waters of the Gulf and the marshes, as the strip mining in Appalachia scars the land there. And then there is Deepwater Horizon, an ecological disaster that may – likely will -- exceed the Exxon Valdez spill in Alaska, a result of the greed of a few and the lack of regulation by the state and federal government. Or, at least, enforcement of regulations.

Make no mistake, Louisiana is capable of passing laws with strict regulations and enforcing them. Take, for example, abortion. Striving to compete with the many other states that have wanted to take the lead in controlling women’s reproduction (see In Ultrasound, Abortion Fight Has New Front by Kevin Sack, NY Times May 27, 2010), Louisiana has passed some of the most restrictive abortion laws in the country. Many of these laws are clearly directed at harassing abortion providers so that they go out of business, and mainly have the effect of harassing the women who are seeking abortions. Recent laws include the requirement that a woman who wants an abortion see an ultrasound of the fetus within 2 hours of the procedure, having the images on the screen described to her, and be given a copy of the ultrasound in an envelope with sonogram results written on the front. There is no exception for fetal demise, rape, incest or anything.

Louisiana’s governor (Bobby Jindahl) and its anti-choice legislature may take pleasure in their “F” rating by the National Abortion Rights Action League (NARAL); the negative impact is suffered by the actual women who are already struggling with having decided that an abortion is the right thing for them, in their lives, at that time, and don’t need this additional harassment from their government. It would be wonderful if the Louisiana governor and legislator could take the same pride in the rigorous regulation of the oil industry in their state, protecting their people and their livelihoods and the environment from destruction with anything approaching the same vigor.

But they can’t take such pride. Because they don’t do it. If they did, we’d be living in a much better world.
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Health Reform: The good, the bad, and the bigoted

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The New York Times, in a December 22, 2009 editorial, calls the Senate bill “well worth passing” (A Bill Well Worth Passing), and says that it is “worthy of support from lawmakers who care about health care reform.” Whether it is worthy of support by the American people is another question entirely. The Times says that there is “…a lot to like in this bill”, and this is certainly true, as there are many parts of it, that include funding for many good programs. Some of the issues that I have written about in the past, such as primary care extension services and funding for primary care education (“Title VII”) are included in the bill. That makes me happy, and I think that they should be good for the health care of the American people.

A proposal that would expand graduate medical education funded by Medicare by 15,000 slots did not pass, which also makes me happy. Through aggressively supported by the Association of American Medical Colleges (AAMC), it has been opposed by family medicine organizations because the expansion would have been willy-nilly, not giving preference to or even a guaranteed base of funding for primary care. While it is true that there are needs for new physicians in areas other than in primary care, any bill that does not absolutely guarantee primary care slots will result in hospitals allocating them to those specialties that make the most money for the hospitals – certainly not primary care. Moreover, the key flaw of counting all students entering 3-year internal medicine residencies as primary care, despite, as I have discussed (recently November 17, 2009 Primary Care’s Image: A Problem?, October 14, 2009 "War on Specialists?": Wall St. Journal defends the status quo!, October 8, 2009 "Uncomplicated" Primary Care?), the fact that the vast majority of them will enter subspecialty fellowship training. There is an excellent Op-Ed on December 23, 2009, addressing this issue in the Times, "Doctors no one needs", by Shannon Brownlee and David Goodman.

What, of course, is less good (or, as we might say, “bad”) is that 1) it doesn’t cover everyone; 2) it will save some money, maybe, but only a small portion of what might be done by a public option, not to mention a single-payer plan; 3) it will make the insurance companies even richer; 4) it will not guarantee affordable health care for Americans. We have already discussed this (December 6, 2009 Health Care Needs Should Guide Health Reform). It has even eliminated the buy-in to Medicare for people over 55. The core problems with the bill are detailed in the letter to the Senators by the leadership of the Physicians for a National Health Program (http://www.pnhp.org/news/2009/december/pro-single-payer-physicians-call-for-defeat-of-senate-health-bill).

But, as the Times notes in its front-page article on the bill (Democrats Face Challenge in Merging Health Bills by Robert Pear and David M. Herzenhorn), “Democrats were grappling Monday with deep internal divisions over abortion, the issue that most complicates their drive to merge the Senate and House bills and send final legislation to President Obama.” And this is indeed the part of the Senate bill, and in the House bill’s Stupak amendment, that gives free rein to the bigots who feel, literally, that it is their God-given right to apply their moral compass to the most important life decisions of the rest of us. In trying to garner the votes of marginal Democrats (like Ben Nelson in the Senate), the Congress has bowed to the efforts of the Catholic bishops to try to not only control the lives of their own believers, but those not of their religion as well. Make no mistake about this. As much as opponents say that they are opposing abortion, what they are actually doing is choosing to make the decisions about it for other people. All of those people who are affected are women, and most of those making the decision – including all bishops – are men.

Trying to reach a compromise (New York Times, Negotiating to 60 Votes, Compromise by Compromise, by Robert Pear, December 20, 2009), the Senate came up with nonsense. “In what they described as an effort to reduce the demand for abortion, Democrats would provide money to help pregnant teenagers and new mothers so that they could stay in high school and attend college. The federal government would provide $25 million a year for a ‘pregnancy assistance fund.’ The money could be used for ‘maternity and baby clothing, baby food, baby furniture and similar items,’ the proposal says.” If they weren’t politicians, these people would be described as, using the technical term, “lunatics”.

If you really want to “reduce the demand for abortion”, the first step, the necessary step, the sine qua non, is to reduce unwanted pregnancies. Amazing idea! How would we do that? Well, one way would be to tell people, convince people, cajole people, pray for people, and bribe people not to have sex, or not have sex with people to whom they are not married, or not have sex when they are not explicitly trying to have a baby. This is, incredibly enough, a very popular idea and strategy. I say “incredibly” because there is no evidence that it works and no reason to think that it might. For all of human history people have had sex, and the people with the strongest urge to do so are just the young people that we are trying to convince not to (ironically, the potency industry for old men, whom nature has decided do not need to have a desire or ability to have sex, is enormous!).

There is compelling evidence that every program designed to keep young people from having sex is a complete, utter, and absolute failure. Indeed, an unending line of ministers and politicians who preach and pontificate about the issue are having sex outside of their marriages, and proving by their behavior the vapidity of their words. It is of no importance to people outside of their immediate families whether they apologize or feel bad. What is important to the rest of us is that, if they don’t have the common decency to stop being politicians and trying to make policy that affects us all, that they abstain from voting on any issue with any sexually-related dimension.

On the other hand, there are much more effective methods for “reducing the demand for abortion”. They are two: widespread, comprehensive and truthful sex education, and widespread, freely available contraception. Unfortunately, I see no support for these measures in the current bills or in the complete blather coming from the mouths of the hypocrites above.
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HR 3962 is still a bad bill, and Stupak-Pitts is a scandal

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After the House of Representatives passed HR 3962 recently, I celebrated the defeat of the opponents of health reform. I tried to make it clear, and I will emphasize here below, that the bill is not only far from perfect, it is bad. I just think it would have been worse, a victory for those who wish to keep the status quo (for example, virtually all the Republicans). To my knowledge, Ohio congressman Dennis Kucinich is the only representative who voted against it from a progressive perspective, and I applaud him for that.

I was at a conference recently at which former Senator Tom Daschle spoke. He invited us to envision a huge stadium with the 300,000,000 Americans in it, and the President at the center asking “what should we do about health reform?”, and the huge multiplicity of opinions that would come. He then suggested that the Congress, with its 535 representatives and senators, was a microcosm of those people, expressing all their multiple beliefs. Well, maybe the multiple beliefs, but not in the same proportion. I feel quite certain that, while there would have been a lot of opponents, the 300,000,000 Americans would have been a lot more supportive of health reform, much more meaningful health reform, than the 535 representatives. This is because they don’t get huge contributions from lobbyists from the insurance industry, pharmaceutical industry, hospital industry, and other big corporations, as well as doctors and lawyers and other rich people. Congress does, and it definitely affects their way of seeing things.

HR 3962 is a bad bill that will finance insurance companies, not save money, and not cover all people. I think, I know, we can do better than that. A single-payer plan, for example, such as that proposed in the Medicare for All bill sponsored by Rep. John Conyers (D, MI), and almost voted on by the house in an amendment by Rep. Anthony Weiner (D, NY) to include single payer. This is actually quite a victory, that it came so close, given the efforts of both the Administration and the Congressional leadership to keep it “off the table” from the beginning of this debate. We can hope that, at least, the amendment sponsored by Rep. Kucinich permitting states to pilot single-payer plans, that passed out of committee with bipartisan support, will be considered. It would be a scandal to not allow those states that wished to to try to model a single-payer program.

Speaking of scandals, HR 3642 is further poisoned by the inclusion of the “Stupak-Pitts Amendment”, named after its sponsor, Michigan Democrat Bart Stupak, which not only continues the Hyde Amendment’s ban on the use of federal funds for abortions, it expands on it, by forbidding any plan that may have anyone getting a federal subsidy from offering coverage for abortion care. No “public option” can offer abortion coverage. This will mean that virtually no insurance policy will offer coverage for abortions, including the ones that do at the current time. Companies could offer two separate policies, so that portion of the population not getting subsidies (above 400% of poverty) could buy the other policy, but there is no evidence that they will do so. Under current state laws, five states offer the possibility of insurance companies offering “abortion riders”, allowed under Stupak-Pitts, but there is no evidence that any of them do. Women do not anticipate that they will need an abortion; like other medical care that may come unanticipated (such as the need for emergency surgery, or a diagnosis of cancer) it needs to be covered in the “regular” policy. See the excellent analysis by Jodi Jacobson, “The ‘Real Life’ Effects of Stupak-Pitts: An Analysis by Legal Experts at Planned Parenthood”, or at the Planned Parenthood site, http://plannedparenthoodaction.org/healthreform/668.htm.

The only exceptions allowed under Stupak-Pitts are for abortions resulting from rape, incest, or danger to the life of the mother. Note that this would not only include danger to the mental health of the mother, but would exclude terminations for fetal anomalies, even those incompatible with life. Thus, as is already the case in states such as Mississippi and Louisiana, which have such laws, women can get prenatal testing with ultrasound and amniocentesis, but have no legal access within their states for terminations if something is demonstrated to be wrong. They cannot even be referred. Luckily, at this time, they can go to other states. The Stupak amendment would make the current situation worse.

A group of at least 40 women in Congress, led by Diana DeGette of Colorado, have signed on to a letter demanding that Stupak-Pitts be removed from any final health reform bill. They deserve all the support that they can get, from other members of Congress, from their constituents, and from those who are residents in districts with representatives who voted for Stupak-Pitts. Note that this effort is led by women in Congress. This, obviously, is not a coincidence. Women are the people who get pregnant, including when it is not planned, including when the fetus has anomalies incompatible with life. There are many women, as well as men, who oppose abortion in the sense that they would not have one, that they might counsel friends and relatives not to have one, but also believe that the ultimate decision about what happens to a woman is hers, not theirs. There are also many women, as well as men, in Congress and in the public, who support the concept of Stupak-Pitts and Hyde and other restrictions on abortion, who believe it is their right to make decisions for other women. But none of the men will ever get pregnant themselves. There are many women who were strongly opposed to abortion who have had abortions because their circumstances were special. No men have had to. The role of men, including, obviously, the Catholic Bishops – who, amazingly, are all men! – in fighting for restrictions on abortion, is grossly immoral and offensive.

President Obama has indicated that he will seek some revision of Stupak-Pitts, as described in the New York Times article “Obama seeks revision of plan’s abortion limits”, but even his position would continue the Hyde Amendment restrictions. This has to stop. Women’s lives and health need to stop being the pawns of politicians.