Thorny Issues in the Abortion Debate $5.00 “He Who Acts Against His Conscience Always Sins.” — St

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vol. xxxiii—no. 1 2012

A Case We Can’t Afford Not to Make Regaining Lost Ground on Funding Abortion Care andrea miller A Perspective on Later Abortion … From Someone Who Does Them willie parker, md A Statement on Later Abortion So, Who Has Second- Trimester Abortions? rachel k. jones and lawrence b. finer

Why We Need to Choose ‘Choice’ ann furedi also: Book reviews by Thomas P. Doyle, Carole Joffe, Gail Grossman Freyne and Sarah Raleigh-Halsing

www.catholicsforchoice.org Thorny Issues in the Abortion Debate $5.00 “He who acts against his Conscience always sins.” — St. Thomas Aquinas

“ Conscience is the most sacred of all property; other property depending in part on positive law, the exercise of that being a natural and unalienable right.” — James Madison

“A good Conscience is the palace of Christ.” — St. Augustine

“ I shall drink—to the Pope, if you please—still to Conscience first and to the Pope afterwards.” — Blessed John Henry Newman

“But no man has a monopoly of Conscience.” — Mary A. Ward

Great minds think alike.

Subscribe to Conscience today $15 for a year’s subscription www.conscience-magazine.org CONSCIENCE editor’s note the newsjournal of catholic opinion

Executive Editor jon o’brien Editor david j. nolan [email protected] Contributing Editor sara morello destigmatizing abortion is vitally important Editorial Adviser rosemary radford ruether Editorial Associate for the health and well-being of women around the world. kim puchir Conscience is published by Catholics for Choice. Catholics for Choice shapes and advances sexual In some (too few) places, abortion care is considered to and reproductive ethics that are based on justice, reflect a commitment to women’s well-being and respect and affirm the capacity of women and men be part of the national healthcare framework, is relatively to make moral decisions about their lives. Catholics for Choice easy to access and does not impose undue financial President jon o’brien Executive Vice President burdens on the patient. sara morello Board of Directors susan wysocki, ph.d., b.s.n., n.p., chair Sadly, in too many places, abortion is a thorny issue. It can be unavailable if sheila briggs, m.a. neil corkery not illegal, and stigmatized beyond all reason. At Catholics for Choice, we are barbara deconcini, ph.d. especially concerned with the obstacles that disproportionately affect poorer daniel a. dombrowski, ph.d. susan farrell, ph.d. women. Social justice demands that neither they—nor indeed any woman—face cheryl a. francisconi, m.s.w., m.p.h. ofelia garcia, m.f.a. difficulties when accessing abortion care. john lesch, j.d. The first of the thorny issues we explore is the controversy in the United eileen moran, ph.d. marysa navarro-aranguren, ph.d. States over whether the state should fund abortion care. In “A Case We Can’t anthony padovano, m.a., ph.d., s.t.d. denise shannon Afford Not to Make,” Andrea Miller argues in favor of public funding. Chris- rosemary radford ruether, ph.d. (emerita) tian Fiala also investigates how various European countries deal with funding Católicas por el Derecho a Decidir, Argentina for abortion and contraception. marta alanis Católicas por el Derecho a Decidir, Bolivia Willie Parker, an ob/gyn, describes why his outlook on abortions changed and teresa lanza monje Católicas pelo Direito de Decidir, Brasil why he now provides them. We also include “A Statement on Later Abortion” in maría jose rosado nunes which leading prochoice advocates state that “healthcare that does not include Catholics for Choice, Canada rosemary ganley access to later abortions does not meet what women, and society, need.” Católicas por el Derecho a Decidir, Chile We continue with statistical analysis from our colleagues at the Guttmacher verónica díaz ramos Católicas por el Derecho a Decidir, Colombia Institute. Rachel Jones and Lawrence Finer answer the question, “So, Who Has sandra patricia mazo Católicas por el Derecho a Decidir, El Salvador Second-Trimester Abortions?” And, in “Between a Rock and a Hard Place,” nubia lazo Jane Fisher, the director of Antenatal Results and Choice, discusses what Católicas por el Derecho a Decidir, España mar grandal happens when people receive a prenatal diagnosis of a fatal, life-limiting or Catholics for Choice, Europe disabling condition. henk baars Católicas por el Derecho a Decidir, México Finally, we move on to the political and advocacy worlds, and examine what maría consuelo mejía Católicas por el Derecho a Decidir, Nicaragua we have learned from past battles and how we should gear up for future ones. mayte ochoa, magaly quintana Ann Furedi, the executive director of bpas, the British Pregnancy Advisory Ser- and bertha sanchez Católicas por el Derecho a Decidir, Paraguay vice, explains why “choice” is an important part of our lexicon. Tracy Weitz then monín carrizo examines the political battles over access to abortion services. In “Lessons for Católicas por el Derecho a Decidir, Perú eliana cano seminario the Prochoice Movement from the ‘Partial Birth Abortion’ Fight,” she argues Design and Production letterforms typography & graphic design that we must not shy away from difficult issues, but rather embrace them as Design Consultants opportunities for educating both those who support us and those who do not. point five, ny A lot of thought and planning goes into every issue of Conscience. We would Catholics for Choice 1436 U St., NW • Suite 301 • Washington, DC like to ensure that those who should be reading it get the opportunity to do so. 20009-3997 • USA • +1 (202) 986-6093 If you know of somebody who should subscribe, or would like us to send them a www.CatholicsForChoice.org [email protected] sample copy, please let us know via e-mail at [email protected]. issn 0740-6835

david j. nolan Editor

vol. xxxiii—no. 1 2012 1 table of contents

“What if we started to create new rules … where we proudly declare support for abortion coverage as a matter of fairness and justice?”

—andrea miller, p12

departments

1 Editor’s Note 43 Body Building: Intervention 4 Letters in Evolution 5 In Catholic Circles Thomas Banchoff’s 39 In Spite of the Embryo Politics: Hierarchy: Ethics and Policy in Understanding Clergy Atlantic Democracies Sexual Abuse gail grossman freyne Brendan Geary and 46 The Ties that Bind: Joanne Marie Greer Religious Communities (eds.), The Dark Night of and Political Change the Catholic Church Timothy A. Byrnes’ thomas p. doyle, jcd, cadc Reverse Mission: 41 Politics and Science: Transnational Religious The Tortuous Road Communities and for Emergency the Making of US Contraception in Foreign Policy the US sarah raleigh-halsing Conscience offers in-depth, cutting-edge coverage Heather Munro 42 Bookshelf of vital contemporary issues, including reproductive Prescott’s The Morning 44 Reports Worth Reading rights, sexuality and gender, feminism, the religious After: A History of right, church and state issues and US politics. Emergency Contraception 48 Postscript Our readership includes national and international in the United States Back Cover opinion leaders and policymakers, members of the carole joffe Index: Abortion Law press and leaders in the fields of theology, ethics and Women’s Health and women’s studies. Worldwide

2 conscience volume xxxiii—no. 1 2012

p12

features 12 A Case We Can’t Afford Not to Make 26 Lessons for the Prochoice Movement from the Regaining Lost Ground on Funding Abortion Care ‘Partial Birth Abortion’ Fight andrea miller tracy a. weitz 17 A Perspective on Later Abortion … From Someone 30 Between a Rock and a Hard Place Who Does Them Deciding about a Pregnancy after a Prenatal willie parker, md, mph, msc Diagnosis of Fetal Anomaly jane fisher 20 A Statement on Later Abortion 34 Who Pays the Piper? 22 So, Who Has Second-Trimester Abortions? Funding for Contraception and Abortion rachel k. jones and lawrence b. finer christian fiala, md, phd 24 Why We Need to Choose ‘Choice’ 36 Contraception: My Health, My Conscience, ann furedi Our Freedom jennifer becker-landsberger

cover: © corbis / inspirestock above: © shutterstock / coolr

vol. xxxiii—no. 1 2012 3 letters

Argentina Lacks Catholic Healthcare approach in their latest Should Be Guided by campaign to insist that Accountability for Women’s Medical Standards, Catholic hospitals and Not Church Politics social services agencies Reproductive Health when phoenix bishop should be allowed to deny Thomas Olmsted revoked contraceptive coverage to the Catholic status of their employees. They seem St. Joseph’s Hospital and to have conveniently Medical Center for forgotten that these hospi- providing a life-saving tals and agencies are not abortion in 2010, he did the churches, but rather arta alanis and Systems exist in Argentina hospital a huge favor. nonprofit entities that Jacqueline Nolley to ensure that public offi- He effectively took that receive millions in tax MEchegaray cials and medical providers hospital out of the line of dollars every year through (“Fighting for Women’s comply with the law—but fire in the “Nuns vs. Medicaid, Medicare and Lives in Argentina,” Vol. they are rarely used to safe- Bishops” battle your recent government grants. xxxii No. 3), provide a guard access to reproductive issue so effectively The struggle over who has hopeful overview of how health services. In our 2010 described (Vol. xxxii the final say on Catholic the decriminalization of report, we documented how No. 3). healthcare policies—the abortion has emerged as a women pay the price—with Is it any wonder that the nuns who founded most human rights issue in their suffering or even with health system to which Catholic hospitals or the Argentina. This is an their death—for the failure St. Joseph’s Hospital bishops who outrank them important connection for to enforce the law. Ana belongs—Catholic Health- in the church hierarchy—is the reproductive rights María Acevedo, a young care West—has just a sad spectacle. A hospital movement to make. A mother diagnosed with announced a decision to license is a privilege, not a woman’s access to safe and cancer, paid such a price. give up its official connec- right, and brings with it a legal abortion is absolutely Doctors refused her radia- tion to the Catholic church responsibility to serve the and inextricably linked to tion cancer treatment and change its name to public—including people her most fundamental because she was pregnant. Dignity Health? Is it any who are not Catholic or, if human rights. However, The hospital denied her surprise that communities Catholic, do not agree with Human Rights Watch has petition for legal therapeutic don’t want their nonsec- the bishops or nuns on such found that changes in laws abortion. She died five tarian hospitals to join issues as contraception. and policies alone are insuf- months later. A criminal Catholic health systems or Hospitals should be guided ficient to protect these court in Santa Fe province merge with nearby Catholic by medical standards of care, rights—there must also be found that her doctors had hospitals because of well- compassion for their patients accountability for putting failed to uphold their public grounded fears that and non-discriminatory them into practice. duties, but though they bishops will interfere with labor practices, not by Our research in Argen- were found culpable for her patient care? church politics. tina demonstrates that the suffering in 2010, they have The bishops are only lois uttley government’s failure to not been sentenced. calling more attention to Director carry out laws and policies Argentina’s laws may their heavy-handed The MergerWatch Project on reproductive health can change, but for change to curtail women’s rights to happen in the lives of life, health, nondiscrimina- women like Acevedo, tion, physical integrity, Argentina’s government freedom of expression and should be accountable for LET US KNOW religion, as well as the right carrying out policies that to decide the number and promote women’s health, WHAT YOU THINK. spacing of children. dignity and rights. amanda m. klasing Please e-mail letters to: Letters may be edited for Women’s Rights Division [email protected] clarity and length. Human Rights Watch

4 conscience in catholic circles

Jay Carney stated at a press “Not everyone wants to talk The Church briefing, “There’s not a about it, but that is a clear debate” over reversing the factor in the decline of the and Contraception decision. “The decision has Catholic community.” been made, and it was made Bishop Sample also traced after careful consideration,” some of the church’s current he said. Pointing out that problems to “poor cate- “there are a lot of folks out chesis” after Vatican II, there who support this which he called a “time of The Obama Administration pocket for reproductive policy,” Carney indicated great confusion”: “While I Sides with Women, healthcare guaranteed to all that in the coming year the certainly don’t blame the Against Bishops’ other American employees. White House will be [Second Vatican] Council, Demands for Expansive Cardinal Timothy M. focusing on helping organi- much upheaval occurred in Religious Exemption to Dolan, president of the zations implement the rule. the Church in its aftermath.” Contraception Coverage usccb, reacted to the deci- Calling for a “renewal in on january 20 kathleen sion asserting, “In effect, the Contraception a catechesis,” Sample specified Sebelius, Secretary of the president is saying we have a ‘Clear Factor’ in Declining that this meant reinforcing Department of Health and year to figure out how to Number of Catholics, the hierarchy’s rejection of Human Services (hhs), violate our consciences.” According to reproductive rights. issued an interim final rule Dolan has vowed to contest Michigan Bishop In 2009, Sample withdrew requiring that no-copay the hhs decision, saying bishop alexander sample an invitation to former coverage for contraception that “the Catholic bishops of Marquette, Mi., told auxiliary bishop of Detroit must be made available in are committed to working Catholic World Report in Thomas Gumbleton, asking the majority of US employee with our fellow Americans to November that Catholics’ him not to speak in the health plans. “This decision reform the law and change use of “artificial contracep- Marquette diocese because was made after very careful this unjust regulation.” tives to limit the size of their of Gumbleton’s support for consideration, including the The administration is families” is to blame for lgbt rights and women’s important concerns some standing by the hhs policy. smaller parishes and the ordination, though these have raised about religious White House press secretary closure of Catholic schools. topics were not going to be liberty,” Sebelius said. “I mentioned in the speech. believe this proposal strikes Gumbleton told Catholic the appropriate balance INFORM YOUR News Service that he and the between respecting religious bishop “worked it out” so he freedom and increasing could have a private meeting access to important preven- Conscience with the peace group that tive services.” invited him. Loreene Zeno A narrow group of reli- Koskey, diocesan director of gious employers, such as communications said, churches and other houses of however, that “[Bishop worship, will be allowed to Sample] still did not want refuse to offer this coverage. [Gumbleton] to come.” The United States Confer- ence of Catholic Bishops (usccb) led an unsuccessful The Church campaign demanding an expansive exemption that and Abortion would have included reli- WITH US Catholics Follow giously affiliated institutions CATHOLICS FOR CHOICE Their Consciences on such as Catholic healthcare Abortion and Sexuality, facilities, charities and Scan with your smart phone to follow the latest news Survey Says universities. This scenario and action alerts about reproductive rights, sexuality on decisions regarding would have forced millions and gender, church and state and individual conscience sexuality and reproductive of women to pay out of on the Catholics for Choice website. health, more than half of US

vol. xxxiii—no. 1 2012 5 Catholics believe that indi- lics say individuals them- aims of the bishops, encap- izing the country’s abortion viduals should have the final selves are the proper locus of sulated in the creation of the laws. The next step is for say, according to the most moral authority on abortion.” usccb’s new Ad Hoc Com - the legislation to pass the recent Catholics in America Overall, the survey mittee on Religious Liberty. lower house, the Chamber survey from the National concluded that only “one in Archbishop William E. of Deputies, controlled Catholic Reporter. five Catholics … says that Lori of Baltimore, who leads by allies of President Jose The fifth installment of church leaders such as the the committee, said at the Mujica, who told the the series, released in pope and bishops are the November event that priests bbc he will sign the bill October, reveals a shift in proper arbiters of right and and laypeople would be into law. Catholic opinion towards wrong” on subjects like enlisted in what the New Currently, women who valuing the individual divorce and remarriage, York Times characterized as a have an abortion or individ- conscience in moral decision homosexuality, sex outside “‘religious liberty’ drive.” uals who assist in abortions making, and away from of marriage, contraception Lori discussed the hierar- can be sentenced to prison. dependence on church and abortion. chy’s recent battles to secure Only those women who are leaders as moral arbiters on special rules for Catholic victims of rape or whose lives issues like abortion, contra- US Bishops’ Meeting service providers receiving are in danger have a chance ception, sex outside of Focused on Politics, federal funding, using Cath- to access a legal abortion. marriage and homosexuality, Abortion, not Economy olic agencies that closed According to a 2004 with each of these categories the annual baltimore their doors rather than help survey, approximately scoring anywhere from five gathering of the United same-sex couples adopt as an 54 percent of Uruguay’s to 11 points higher in terms States Conference of illustration of the threats population is Catholic. A of the individual’s right to Catholic Bishops (usccb) faced by the church today. change in the country’s decide what is ethical. This reflected the hierarchy’s “Church insiders say the culture may be indicated by is in comparison to the priorities for the coming hierarchy’s internal political the fact that it was the first previous poll from 2005, year, with usccb president dynamics are driving the Latin American nation to which revealed very similar Cardinal Timothy M. Dolan new, narrow focus,” legalize civil unions for attitudes to the 1999 survey. emphasizing the church’s according to Religion News same-sex couples. Opinion Compared to the data from political agenda on issues like Service, which said that polls reflect that the the first year, 1987, more US abortion, religious liberty “opposition to same-sex majority of people in Catholics have moved away and same-sex marriage in his marriage and abortion are Uruguay favor reducing from the sole reliance on presidential address. simple, black-and-white legal obstacles to abortion. church leaders’ moral direc- The November gathering issues that all bishops can A similar bill was vetoed tion, with the number of took place against the back- get behind.” by President Tabare people following the hier- drop of a bleak economic Vasquez in 2008. The archy’s leadership on abor- landscape and shortly after Uruguay Senate current measure was tion dropping from 29 the indictment of Kansas Passes Bill to debated for over 10 hours in percent in 1987 to 19 percent City-St. Joseph Bishop Decriminalize Abortion the Senate before finally in 2011. Those who look only Robert W. Finn on charges in late december passing in the face of some to church leaders for deci- of failing to report suspected Uruguay’s Senate voted opposition, according to sions about sex outside of child abuse. The agenda, to decriminalize abortion Reuters. The bill is on the marriage, homosexuality and however, featured sessions in the first 12 weeks of docket to be debated in abortion dropped 18 points, on diocesan financial pregnancy, passing the the Chamber of Deputies 16 points and 10 points, oversight and the political first hurdle towards liberal- in March. respectively, since 1987. “We don’t have the right to The findings reveal that pass moral judgment by Catholics who attend Mass saying that the woman who regularly or who belong to LET US KNOW continues her pregnancy and the pre-Vatican II cohort are has her baby is in the right more likely to defer to the WHAT YOU THINK. whereas the one who doesn’t, teachings of church leaders. for whatever reason, is in the The Reporter pointed out, Please e-mail letters to: wrong,” said Senator Monica however, that “half of the [email protected] Xavier. “We’re not moral oldest generation of Catho- censors, we’re legislators.”

6 conscience in catholic circles

The Church and State Prochoice Catholic Governor Stands up to Cardinal on Abortion Issue in mid-december, Chicago’s governor, Pat Quinn, met with Illinois bishops, though the politi- cian and the hierarchy differ as to the substance of the pastoral visit. The two sides clashed in November over the award Quinn presented to a prochoice advocate, later revealed to be a rape victim. The most recent dispute was

over the governor’s charac- larry downing / terization of the December meeting as mainly focusing reuters on the poor: “A lot of the © discussion was how we could Illinois Governor Pat Quinn pictured in front of the White House in 2010. work together to fight poverty,” Quinn remarked providers, such as Catholic and these are not at issue to the Chicago Sun-Times. adoption agencies, are still with regard to Ireland,” The Church In a statement, the bishops required to follow civil laws, according to a statement and Culture contested this summary, stating, “We can’t allow published by the Vatican writing, “From our point of anyone not complying with Information Service. Benetton Ad of Kissing view … this was a meeting the law to continue to hold Despite the conciliatory Pope Pulled after between pastors and a a contract.” language from both sides, Vatican Complaint member of the church to the timing of the announce- benetton, the italian discuss the principles of Ireland Closes Embassy ment is significant. The clothing company known for faith.” The letter singled out to Holy See news broke in November, its provocative advertise- the governor’s justification by closing its embassy just six months after Prime ments, pulled its ad of his sympathetic stance to the Holy See, Ireland Minister Enda Kenny depicting Pope Benedict xvi towards abortion rights and stands to save 1.25 million blasted the Vatican’s kissing a Muslim cleric in lgbt rights, saying that “the euros a year, but it may response to the sex abuse November after the Vatican Catholic faith cannot be prove more difficult for the crisis and Archbishop announced its intention to used to justify positions Vatican to save face after this Guiseppe Leanza, papal take legal action. The contrary to the faith itself.” symbolic action. nuncio to Dublin, was digitally manipulated By contrast, Gov. Quinn The decision was made recalled to Rome. images of the pope and said that the conversation with “the greatest regret and “This is really bad for Sheikh Ahmed Mohamed touched only “a little bit” on reluctance” according to a the Vatican because Ireland El-Tayeb were part of the his prochoice stance and statement from the Irish is the first big Catholic company’s “unhate” support of lgbt couples’ foreign ministry quoted by country to do this and campaign to promote right to adopt. the bbc. Vatican spokesman because of what Catholicism tolerance, the latest in A spokesperson for the Father Federico Lombardi means in Irish history,” Benetton’s attention- governor declined to said after the decision, said a Vatican diplomatic getting advertisements, comment on the bishops’ “What is important are source who spoke to which have featured death letter. Quinn did emphasize diplomatic relations between Reuters on the condition row inmates and a person that faith-based service the Holy See and the States, of anonymity. dying from aids.

vol. xxxiii—no. 1 2012 7 orders and dioceses of the Dutch Catholic church,” the commission that authored the report said to the afp news agency, “but the appropriate actions were not undertaken.” The Dutch Catholic church has announced it will begin compensating victims. One sexual abuse survivor, Bert Smeets, told the Associated Press that the report and the official response were inadequate because “all sorts of things happened but nobody knows exactly what or by whom. stefano rellandini stefano / This way, they avoid responsibility.” Of the

reuters 11 cases the commission © A man walks by the Benetton store in Rome, where the clothing retailer’s latest ad campaign features the image of Pope referred to prosecutors, only Benedict xvi kissing an imam, later banned after Vatican complaints. one had enough information to open an investigation, The Vatican’s Secretariat Lombardi of the Holy See President Obama was also and none of the cases named of State released a statement Press Office expressed a featured in a similar image the perpetrators. condemning the ad in which “resolute protest at the with Venezuelan President “the Holy Father appears in a entirely unacceptable use of a Hugo Chavez. The White Vatican Quietly Accepts way considered to be manipulated image of the House has expressed its Cardinal Law’s Retirement harmful.” Father Federico Holy Father.” displeasure but has not yet in november cardinal taken legal action. Bernard Law left his position as archpriest of the Hubert Tournès, Advocate and Friend, Remembered prestigious St. Mary Major The Church and basilica at age 80, the official A dear friend and colleague, Hubert Tournès, passed away retirement age for the posi- last November. He was the cofounder and deputy chairman of Sexual Abuse tion, though it is common the Association Droits et Libertés dans les Eglises/Rights and Report Details Sexual for cardinals to stay on past Freedoms in the Churches (1987) and cofounder of the Abuse Cover-up in Dutch that age. That the cardinal European Network European Church on the Move/Réseau Catholic Institutions was allowed to age out of Européen Eglises et Libertés (en/re, 1981). He was a member the dutch hierarchy office is significant, given of the coordination group and a member of the team for failed to address widespread that for many Law symbol- relationships with European institutions in charge of reports of sexual abuse in izes the worst of the hierar- representing the en/re with the All Party Group on the schools, seminaries and chy’s response—or lack of Separation of Religion and Politics. He previously worked for orphanages, according to an response—to the clergy the European Union in Brussels and in various public bodies, independent report released abuse crisis. both in Algeria and in France. He also found time to be a in December. As many as Law held on to his posi- member of the French Ligue des Droits de l’Homme, and was 10,000 to 20,000 minors tion as archbishop of Boston an elected lay member of a decision-making clergy/lay were abused in Catholic for nearly a year after disclo- pastoral team in a Parisian parish during the 1980s. Hubert institutions between 1945 sures that he had allowed worked closely with Catholics for Choice on a number of and 1981, with “several thou- priests accused of abuse to projects in Europe and at the European Parliament. His sand” cases of rape reported. remain active in parishes. commitment to progressive Catholicism, equality and human “The problem of sexual He stepped down in 2002 rights will be sorely missed. abuse was known in the after records revealed letters

8 conscience in catholic circles

that Law had written Kansas City Bishop Agrees The Kansas City Star 45 to 54 had the most unfa- praising priests he knew to to Supervision to Avoid reported that dioceses in vorable views of the church, be pedophiles. More Criminal Charges New Hampshire, Ohio and but 46 percent of Irish Cath- Less than two and a half after being indicted in California have agreed to olics between 25 and 34 also years later, Cardinal Law led Jackson County, Mo., for similar deals to avoid prose- had an unfavorable opinion a memorial mass for Pope failing to report a priest cution. Some victims’ advo- of the church. John Paul II in Rome amid accused of taking inappro- cacy groups have criticized some protests, according to priate photos of a minor, the arrangement, calling it Endnotes the New York Times. Just a Bishop Robert W. Finn of a “free pass.” few days before the the Diocese of Kansas City- Bishop Resigns after announcement, the Boston St. Joseph agreed to monthly Poll Shows Irish Revelation that He Has Herald reported on a “lavish” meetings with a prosecutor Catholics’ Unfavorable Two Children 80th birthday celebration from neighboring Clay View of Church los angeles auxiliary in honor of the cardinal, County to avoid additional twenty-eight percent Bishop Gabino Zavala attended by clergy in criminal charges. of Irish Catholics have a resigned in early January Vatican City. According to Finn will be required to “very unfavorable” view of after telling Los Angeles a guest, Cardinal Camillo report all possible episodes the church, while 19 percent Archbishop José Gomez in Ruini, “[Law] threw the of abuse to Daniel White, have a “mostly unfavorable” December that he has two party himself.” prosecuting attorney of Clay attitude, according to a poll teenage children. Catholic Just three weeks later, in County, or face prosecution of Irish Catholics conducted News Service reported that what amounted to an official for misdemeanor charges. in late 2011 by the Iona the Vatican’s announcement slap in the face, the docu- White described the super- Institute. Two of the nega- of Zavala’s departure cited ment communicating Law’s vision requirement as more tive factors identified by only the canon law that replacement named his stringent than being prose- respondents were child allows bishops to resign if successor, Archbishop Santos cuted for a misdemeanor, abuse (cited by 56 percent) they are ill or otherwise Abril y Castelló, but did not which would have been “a and the cover-up of abuse unfit for office. mention Law’s retirement. slap on the wrist.” (18 percent). Individuals aged “The archdiocese has reached out to the mother and children to provide spiritual care as well as funding to assist the children with college costs. The family’s identity is not known to the public, and I wish to respect their right to privacy,” Archbishop Gomez said in a written statement. Father Alberto Cutié, a former Catholic priest who is now a married Episcopalian priest, commented on the situation in the Huffington Post. “When a priest fails to keep celibacy, that man-made rule that even the Roman Catholic Church admits is changeable, adaptable and dispensable, we should not be so easily scandalized,” Cutié alessia pierdomenico / wrote. “Sexuality among consenting, single adults reuters

vol. xxxiii—no. 1 2012 9 Be Catholic. Be Pro

The information contained in the publications below, and others available from Catholics for Choice, will enhance your faith and your principles and help you repudiate the arguments of those who oppose women’s rights, reproductive rights, the separation of church and state and church reform. In Good Conscience: Respecting the Beliefs of Healthcare Providers and the Needs of Patients ($5 each) Conscience clauses in the United States, Latin America and Europe are discussed in this series of publications. Each publication answers many questions, including: Who should conscience clauses protect? How do they affect patients who need reproductive healthcare? How does one follow one’s own conscience while providing ethical treatment for all?

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vol. xxxiii—no. 1 2012 11 restrictions restrictions on abortion funding, such as access abortion poor to care. women, the hyde amendment, make especially women, for it more difficult 12 conscience A Case We Can’t Afford Not to Make regaining lost ground on funding abortion care

By Andrea Miller

ecently, i received a phone prochoice allies and our movement by cre- call that elicited equal parts pride ating a storyline of loss. The other voice, and dread for a prochoice spokes- though, tells me that this is gut-check time: person like me. The call was from we can’t ignore our core value of justice for the editor of this magazine asking all women. This is especially true given that Rme to pen a piece about the Hyde Amendment the lack of public funding renders the right and public funding for abortion, a topic that to choose virtually meaningless for some of has become a “third rail” issue—something the most vulnerable women among us. electrified that most people don’t want to I am writing this because, ultimately, both touch, both inside and outside our movement. whispers are true and should be respected. Why would this topic cause dread in They tell a complex, but not competing, someone with an unwavering personal and story which need not prevent us from moving professional commitment to supporting ahead with an agenda that includes a pas - public funding to help make the right to sionate defense of public funding for abor- choose a reality, and who firmly believes that tion care, an agenda that lets our whispers the prochoice community shares that view? about reproductive justice become roars. When I think about public funding for abor- That’s because I believe that our move - tion, two competing voices whisper in my ment—and the public—are at a crossroads. ear: one reminds me that public funding is a More conversations than ever are taking political nonstarter because conventional place at every level of society about how wisdom says we have neither the votes nor abortions are paid for, the role of govern - the public on our side. This voice insists that ment in ensuring coverage for healthcare focusing on public funding will hurt our (including abortion), as well as the role of insurers in making care more or less accessible. Initially, this conversation opened the ANDREA MILLER is president of naral Pro-Choice New York and the National Institute floodgates to new attacks on abortion cov- for Reproductive Health. She previously served erage in the private marketplace, which our as executive director of naral Pro-Choice movement is working valiantly to hold back. Massachusetts, co-owned Public Interest Media And current political realities make it Group, a national communications and PR firm, difficult—if not impossible—for us not to be and helped to found the Center for Reproductive Rights. She wishes to thank her colleagues, tempted to pivot by stating that public Kelly Baden, Tara Sweeney and Angela Hooton, funding is not the issue at hand. We feel for their contributions to this article. backed into a corner, forced to tacitly accept

vol. xxxiii—no. 1 2012 13 the panoply of restrictions on public increasing the number of states that have long one with some rockslides likely funding at the federal, state and local adopted similar provisions. along the way—for support of abortion levels in hopes of mitigating further Our opposition is looking far beyond coverage, regardless of who foots the damage to women’s access to abor - what we in the prochoice movement have insurance bill. tion care. traditionally considered to be public In the summer of 2010, the National Yet, tellingly, prochoicers are still funding for abortion. They have set their Institute for Reproductive Health (nirh) losing ground—even in the area of public sights on making abortion as inaccessible conducted opinion research to better funding’s presumably more popular sister, and stigmatized as possible. And they understand attitudes about private insur- private insurance coverage for abortion. hope that we tie ourselves up in knots, ance coverage for abortion among pro- And the definition of public funding for trying to parse out what is public funding choice supporters and those who could, abortion itself keeps changing. Our oppo- and what is not. hopefully, be persuaded to support our sition keeps shifting the goalposts. I propose that instead, we should position. The timing was critical because, So let me ask you: Would you con - embrace the nuance and seize on the as I could already attest from my recent sider funding for medical training that opportunity presented by a nascent blur- tenure as executive director of naral Pro- includes education on abortion provi- ring of the distinctions between public Choice Massachusetts, passage of a sion to be public funding for abortion? and private, thanks to the national dia- healthcare law—even one that maintains What about family planning funding for logue on health reform. At the risk of (if not expands) coverage for reproductive any entity that also provides abortion sounding like a Pollyanna, I believe that healthcare, including abortion—is not the care, even though the dollars spent on we can use this moment to create a new end of the debate over the state’s health abortion care are segregated from the conversation and forge a path—albeit a policy. As the last year has shown, the vit- family planning dollars? Or government riolic debate over abortion coverage in the subsidies to purchase health insurance Patient Protection and Affordable Care if that insurance adheres to the industry Act only signaled the beginning of the standards for providing abortion cov- The Hyde contention between policymakers and the erage? Is it public funding for abortion Amendment public over how abortion is paid for and if if you spend funds in your personal it is covered by insurance. (While this was health savings account for abortion In 1976 Congress passed the Hyde originally written in January 2012, these care? Or if a charitable organization that Amendment to ensure that abortion words ring even truer in light of the fight provides or refers for abortion care gets is not funded through Medicaid, over whether the no-copays for preventive a state tax credit? In 2011, antichoice law- except in limited cases. Named after care will extend to contraceptives, regard- makers in Congress and state houses Rep. Henry J. Hyde (R-IL), the less of where a woman works.) throughout the country classified all of amendment is a rider to the Labor/ The nirh research findings caused a the above, and more, as public funding Health and Human Services/ real “aha” moment for me. Something for abortion. Education appropriations bill, which interesting surfaced in the focus groups So what exactly is public funding of is renewed annually. conducted in Raleigh, NC; Minneapolis; abortion? I’d say that maybe the answer The exact wording of the excep- Denver; Pittsburgh and Kansas City, shouldn’t matter to us. Today, when anti- tions to the Hyde Amendment has Mo.; among prochoice women and men choice lawmakers talk about stopping changed over time. Currently, the and those who agreed with some pro - public funding for abortion, they are not federal Medicaid plan does allow for choice positions, described as “mixed just talking about enshrining the Hyde abortion funding in cases of rape or choice.” The healthcare debate—the Amendment, that decades-old restric- incest, as well as when the preg- Stupak amendment; the Nelson “com- tion on using federal dollars to cover a nancy threatens a woman’s life. promise,” a public option versus govern- woman’s abortion care (except if her life Since Medicaid coverage extends ment subsidies for purchasing private is endangered or she was sexually to people with lower incomes, the insurance; the relationship between cov- assaulted) if she relies on Medicaid for Hyde Amendment disproportionately erage and access to care; and the chal- her healthcare. Nor are they referring affects poor women’s reproductive lenges so many face getting either or only to the Hyde Amendment and its choices. Other federal programs both—had trickled down in such a way many iterations affecting public have instituted prohibitions on that these pro- and mixed-choicers were employees, women in the military, funding for abortion, including those seeing less of a distinction between pri- women living in the District of Columbia, for women who are Indian Health vate insurance coverage and public women who get care through Indian Service clients, Peace Corps volun- insurance coverage of abortion services. Health Services and more. They are also teers and military personnel and This changing sensibility was echoed not simply seeking to expand that list by their spouses. in the responses to the companion

14 conscience a case we can ’t afford not to make national online poll, which surveyed 1,211 I believe that the focus group partici- health reform as a woman’s issue. We voters who believe: (a) abortion should be pants and poll respondents were picking will see major changes in the insurance legal and generally available (group 1); (b) up on a phenomenon that will become market trends in coverage over the next regulation of abortion may sometimes be much more pronounced in a post- several years, along with the increased necessary although it should remain legal Affordable Care Act world: people’s involvement and responsibility of in most circumstances (group 2); or (c) health insurance status is not static. In consumers related to their insurance abortion should be legal in only the most the coming years, they will be moving coverage. I believe this creates a new extreme cases, i.e., life, rape and incest back and forth even more often between opportunity to begin building support (group 3). To be clear, voters who believe utilizing employer-sponsored insurance; for abortion coverage, including ulti - all abortions should be illegal, who we purchasing private insurance (in the mately removing the restrictions on both typically assume comprise roughly 15 per- future this may be on an exchange); public and private insurance. cent of the population, were excluded receiving subsidies for insurance; and How can the prochoice movement from the research because the goal was to using public insurance. This will depend capitalize on this new landscape, where assess what might motivate voters to sup- on myriad other factors in their lives: job the public better understands the shifting port protecting private insurance cov- status, marital and family status, income source of one’s insurance coverage? We erage of abortion. (We don’t ever expect level, residence and more. can do so by consistently and forcefully to garner support from those who believe A Latina participating in the Denver maintaining that a woman deserves cov- abortion should be completely illegal in focus group expressed her point of erage for the care she needs, including all circumstances.) But among all of those view thus: abortion care, no matter where her insur-

You don’t use polling and messaging to determine your values; you use them to figure out how to best convey your values to those you need to reach.

polled, 62 percent agreed that both private “Who has the right to tell people that ance comes from. From this position, we health insurance and insurance paid for they can’t have insurance that covers can legitimately argue for abortion access with government funding should cover abortions? Because they’re low-income or for all women, with coverage for abortion abortion, including a majority of women because they’re not getting insurance care playing a vital role in making those who lean toward being antichoice. (For through a job like I am? I just don’t think services available. (If I may aim really full disclosure, the question provided 4 people have that right.” high, this will also allow us to speak about options, the others being: private insur- abortion in a way that brings it back into ance [20 percent], health insurance should This sentiment may be indicative of a the context of healthcare.) not cover [16 percent] and “health insur- public that has become less invested in From here, I believe, we can begin to ance paid for with government funding” using demarcations of where a person’s reclaim the ground lost on the Hyde [2 percent].) insurance comes from to determine what Amendment and its many insidious I won’t pretend that a national poll kinds of services are covered. This is incarnations in federal and state laws. with the wording “taxpayer funding for probably because they are more aware This would steer us away from implying— abortion” would be likely to show wide- now that, if they are on one side of that even inadvertently—that public funding spread public support. But that’s because line today, they could be on the other side of abortion is a completely lost cause. We this phrasing is the opposition’s clarion of it tomorrow. So, it becomes a matter of could argue against public funding bans call, not ours. What matters is that, when fairness: if abortion coverage is available as an unacceptable compromise in the asked to choose between agreeing that to some, it should be available to all. abortion debate. After all, as we’ve been “it’s wrong to deny women coverage for Women, historically, have been espe- reminded so powerfully of late, if the a legal medical procedure like abortion cially susceptible to what is known as antichoice lobby had their way in defining just because some people do not approve insurance “churning,” meaning that “public funding,” any alleged “compro- of it” or agreeing that “taxpayer money their insurance status is highly unstable mise” would create a slippery slope—and should not be used to pay for health plans as they move between types of coverage a whole new set of policies that under - that cover abortion,” 60 percent of ones, (employer vs. government) or between mine a woman’s access to abortion care. twos, and threes agreed with the state- being covered and not. This is one of the Advocates for abortion rights are ment that reflects our values. many reasons that so many of us saw working on the front lines every day to

vol. xxxiii—no. 1 2012 15 a case we can ’t afford not to make stem the tide of antichoice legislation tion coverage without distinctions can choice means fully embracing what has sweeping the nation. In a Congress that better pave the way for future efforts to sadly become clear for so many more barely supports family planning funding, restore public funding for abortion. among us of late: you cannot underesti- and in state houses that enacted 69 anti- I’m not going to claim that there is a mate the power of economic status and choice measures in 2011, prochoice orga- single, silver bullet message that will pro- its relationship to access to healthcare. nizations are battling mandatory delays, tect our prochoice elected allies, persuade Surely, promoting a prochoice agenda unnecessary ultrasound requirements, the mixed-choice public and reorient the that asks for the complete repeal of pre-viability abortion bans, attacks on debate over abortion in the United States. funding bans on abortion is an uphill family planning and onerous regulations But I have learned two critical lessons battle. But we’re no strangers to hills, and on abortion providers. Bans on private over the years. First, you don’t use polling this one is critical. We must defend all insurance coverage for abortion have now and messaging to determine your values; kinds of coverage of abortion care in joined the list. So how can we and our you use them to figure out how to best order to defend any kind of coverage for allies be asked to fight for public insurance convey your values to those you need to abortion care, and we must start now coverage of abortion? The real question, reach. Second, you need to know where before we lose any more ground. though, is how can we not fight for it? people are in order to know how to get Those in the movement who count the If the health reform fight and the losses them to where you want them to be. We votes know we don’t have them right now. we saw in 2011 can teach us something, it know what our values are, and the post- Those in the movement who talk to may be that sidelining public funding of healthcare reform landscape has put the elected officials and candidates know that abortion from other abortion-rights public in a place to be able to move toward speaking out against the Hyde Amend-

How can we and our allies be asked to fight for public insurance coverage of abortion? The real question, though, is how can we not fight for it?

efforts has forced us to play by rules we us. Research has taught me that people ment can hurt politicians. But I am did not create in a game we cannot win. can be prochoice and also believe that life hopeful that if we begin to operate within What if we started to create new rules—a begins at conception or that abortion a new framework, we can begin to say new discourse where women are not ends it. Similarly, I believe that we need “no” to the choice our opponents want to divided by their insurance coverage status, not get the public to embrace “taxpayer create for us, which is really no choice at where we proudly declare support for funded abortions” in order to get their all. We can find ways to better reconcile abortion coverage as a matter of fairness support for abortion coverage writ large, our short-term goals with our long-term and justice? I believe this is the way we can private and public. vision of overturning the Hyde Amend- begin to change the conversation. There is power—philosophical and ment in all of its forms. As much as we might want to sidestep political—in speaking consistently about I know in my head and my heart that discussions of abortion coverage in the the importance of abortion coverage for all of us in the prochoice movement want hopes of avoiding a public fight, anti - all women. We can capitalize on women’s the same thing: we want a woman to be choice forces simply won’t let us. As unwillingness to buy into the divisions able to make personal, private decisions tempting as it might be to think that that have been created for us—those with about her reproductive health and have throwing them a “bone” (like the Hyde private insurance and those without— access to the services she needs, including Amendment) could help us at least main- because we don’t have to just talk about abortion care, no matter her income, tain the status quo, it will not satisfy protecting what a woman can do with her insurance status, employment status, them. The drumbeat to “stop taxpayer own private money when purchasing geography, citizenship status or race. funding of abortion” (which the polling insurance on an exchange. We can Maligning coverage of abortion care in shows is a line that still resonates power- instead choose to talk about our under- public plans has worked for the anti - fully with the public) only grows stronger, lying core values that all women deserve choice movement for decades. Now it’s more expansive and harder to fight. We the same peace of mind that they can our time to use the public’s sensitivity to can’t ignore it. Nor can we rewind and obtain the healthcare they need, regard- issues related to healthcare access created erase the past. But we can move forward, less of where their insurance comes from. by the health reform debate to advance together, with a renewed commitment to Abortion has always been accessible our core values and support abortion understanding how talking about abor- for women of means. To truly be pro - coverage for all. I

16 conscience A Perspective on Later Abortion… From Someone Who Does Them By Willie Parker, MD

am intrigued by some reproductive rights advocates’ increasing willingness to search for “common ground” with abortion opponents, evidenced by a recent conference Iconvened with this purpose at a major university. Prior to the conference, one of its organizers, long-time reproductive rights supporter and former Catholics for Choice president Frances Kissling, expressed sentiments representative of this disturbingly conciliatory tone:

“As long as women have an adequate amount of time to make a decision, and there are provisions for unusual circumstances that occur after that time, I would be satisfied [with early gestational age limits to abortion].… Women have Willie J. Parker, md, mph, msc , is a board-certified ob/gyn practicing in Washington, DC. an obligation to make this decision as soon as they possibly can.” efforts towards a more civil public dis- willing to engage in dialogues that— In short, the abortion debate has come course in principle, as a provider of while appearing to progress towards a to include abortion supporters and second-trimester abortion services, I find more civil exchange with abortion sup- opponents bargaining about restricting this trend problematic and dangerous to porters—unwittingly enlist the energies second-trimester abortion as a means of the health interests of women. I am also of abortion rights activists for the restric- seeking common ground. While I applaud troubled by the question—to whom, tion of those rights. These conversations other than themselves, are women obli- subtly endorse the parsing away of this WILLIE J. PARKER, MD, MPH, MSC, is board- gated “to make their decision as soon as fundamental human right, ironically certified in obstetrics and gynecology and they possibly can”? beginning with women in their second trained in public health and family planning. He is on the board of Physicians for Apparently recognizing that termina- trimester, who often have the most com- Reproductive Choice and Health and resides tion of pregnancy won’t be outlawed any pelling need to have an abortion in the in Washington, DC. time soon, abortion opponents are first place. As is common in discussions

vol. xxxiii—no. 1 2012 17 of abortion, absent from these dialogues According to Dr. King, what made the refused to name who impregnated her, are the voices of the women and families Good Samaritan “good” was his refusal our best judgment was that it did not that are affected—the very women who to place himself first, asking instead, indicate incest. In talking to her to are and will be denied access to what is “What will happen to this person if I determine “who” desired the termination, oftentimes a health-related decision. don’t stop to help him?” Similarly, I she did not want to be pregnant and was The lives of these women and their asked the simple question of myself, not being coerced, but the stark reality of families are what compelled me to add “What happens to women who seek just how young she was became explicit abortion care to my practice, mid-career, abortion if I don’t serve them?” This when she expressed her chief concern: when I was no longer able to weigh the radicalized me, leaving me more con- she had missed three days of school and life of a pre-viable or lethally-flawed, cerned about the unnecessary peril to wanted to be with her friends. I safely viable fetus equally with the life of the women when safe abortion services are terminated her pregnancy and restored woman sitting before me. My intent here not available than about what would her childhood by allowing her to have the is to share why I provide abortions. The happen to me if I helped women in this only concerns an 11-year-old should have. times in which we live call for a thought- way. It was at that point—some eight ful, compassionate, evidence-based years ago—that I began to perform abor- A 13-year-old girl was a victim of incest by approach to women’s healthcare that tions, compelled by women’s situations her uncle who had lived with the family should empower healthcare providers to and moved to action by their need, and for six months. By the time the girl’s include abortion in their practice— by my respect for their moral agency to mother discovered her pregnancy, she second-trimester abortions included— make such a decision. was 17 weeks along. Her quiet demeanor,

The women I see in these situations are pregnant and they can’t be or don’t want to be. They are resolving dilemmas created by circumstances unique to their private lives, and certainly unknown to their critics who judge from afar. because of the women who, in the absence The stories of the women who come to interpreted by her mother as ideal of these services, would die unnecessarily. me are what move me to overlook the behavior, unfortunately delayed the I did not provide abortions for the well-established danger of antiabortion detection of her pregnancy. We first 12 years of my career as an obstetri- violence to do this work. Approximately performed her abortion, but the family cian/gynecologist, even though my work one in three women in the US will termi- was understandably deeply shocked by allowed me to see first-hand the repro- nate a pregnancy in her lifetime. While the circumstances of the abortion. ductive dilemmas and outcomes that the epidemiology of women who have women and families face. While recog- abortions gives a general impression of A 32-year-old attorney, senior staff for a nizing that abortion was a need in my who they are—40 percent of US pregnan- prominent US senator, came in with a patients’ lives, I grappled with the cies are unplanned, with about half of this desired pregnancy at 20 weeks, morality of providing them, as I came number unwanted—it is the specific complicated by a lethal fetal anomaly. By from a traditional religious background realities of women who seek abortion, the time diagnosis was confirmed, she was that considered abortion to be wrong. It especially in the second trimester, that 23 ½ weeks. She and her husband were is said that when you grapple with your best inform us. The stories of the fol - distraught, as this was their first child, but conscience and lose—you actually win. lowing women and girls that I have cared resolute that this was the right decision I “lost” that 12-year battle about whether for provide a small glimpse into their for them. Compounding the horror of or not to provide abortions while lis - reality of unplanned, unwanted or wanted their situation were the delay and struggle tening to a sermon by Dr. Martin Luther but lethally-flawed pregnancies: they experienced when her federally- King, Jr. funded health insurance initially refused Dr. King related the story of the An 11-year-old was discovered by her to cover her abortion. I performed her Good Samaritan to encourage compas- grandmother to be 19 weeks pregnant the procedure without complication, for sionate action on behalf of others. The day before she was to start sixth grade. A which they were effusively grateful. story tells of an injured traveler who was trip to an emergency room confirmed the ignored by passersby until one person, pregnancy, leading the family to seek The difficult circumstances described the Samaritan, stopped to help. abortion services. While the young lady above are typical for second-trimester

18 conscience a perspective on later abortion … from someone who does them abortions, with pregnancy detection and the children they want, raise the chil- is a reality, women are empowered to decision making often occurring late. dren they have and plan their families maintain their dignity. The women I see in these situations are through safe, legal access to abortion I endeavor to move our world to a pregnant and they can’t be or don’t want and contraception. In order to make place where women have the space and to be. They are resolving dilemmas cre- these rights a reality, the movement rec- power to make these tough decisions ated by circumstances unique to their ognizes that RJ will only be achieved without judgment, coercion or restric- private lives, and certainly unknown to when all people have the economic, tion thrust upon them, and are able to their critics who judge from afar. I social and political power to make do so in a setting of safety and uniform define a dilemma as a situation in which healthy decisions about their bodies, access to all possible reproductive one has to decide between nondesirable sexuality and reproduction. To be cer- options. It is in this context that I gladly options without the luxury of foregoing tain, when reproductive justice is provide first- and second-trimester abor- the decision. present, abortion is available as a choice, tion access for women in support of their It is in this context that I understand but in the RJ framework all reproductive humanity, dignity and health. I chal - the abortion care that I provide—in the decisions are valued equally. When RJ lenge my peers to do the same. I first or second trimester. While their stories might differ, what all pregnant women have in common is the increasing difficulty in abortion access, especially for later abortions. Ironically, it is the lack of access to abortion care that oftentimes delays abortion to the second tri- LET US mester. A pregnancy in this timeframe is troublesome to those who are in what a friend calls the “mushy middle”—people KNOW who approve of abortion access abstractly, but who become conf licted about its spe- cifics, e.g., termination beyond the first WHAT trimester. Eighty-five percent of women in the US live in a county where there is no access to abortion and, if later gesta- YOU tional age is taken into account, that access is even more limited. That reality, along with my patients’ compelling indi- THINK. vidual stories, compels me to provide the abortion care that I do, moved to help women in these crisis moments and to prevent the unnecessary health consequences that occur when safe abortion is Send in your letter not available. The reality is that some women have to the editor and receive pregnancies that they did not plan and a free copy of have no desire to continue and, therefore, they seek abortion—legal or not, Catholics for Choice’s safe or not. I believe that it is their right to do so, in the second trimester or the “In Good Conscience.” first, that right being rooted in their moral agency as human beings. Thus, I advocate for reproductive justice (RJ). The RJ movement, as distinct from Please e-mail letters to: “reproductive choice,” places reproductive health and rights within a social [email protected] justice and human rights framework. RJ supports the right of individuals to have

vol. xxxiii—no. 1 2012 19 A Statement on

In 2010, Catholics for Choice convened a meeting about later abortion with another organization, Advancing New Standards in Reproductive Health, to provide a chance to discuss a topic even seasoned advocates are not well informed about and to explore what, if anything, can and should be done for women who need later abortions.

We heard from experts about a range of issues in the current debate, including fetal survivability and viability, fetal pain, mental health and fetal abnormalities. We had a frank and thoughtful conversation about what this new information means for our organizations individually and for the movement as a whole, something that Catholics for Choice has carried forward in our work. From this work came the following statement—not intended or designed to be an all-encompassing or exhaustive statement but more a moral and ethical assertion as to how we feel about this issue, why we think this issue matters and why in good conscience we must address it.

As organizations, we believe in bodily autonomy and leave, subsidized childcare, quality prenatal care and a woman’s right to choose whether and when to have expanded educational opportunities for pregnant a child. We also believe in the right to receive safe teens. Support for free, accessible contraception has medical care. always been a cornerstone of this agenda. We have argued consistently for all these things. Access to We stand with women who need abortions later in abortion is an inextricable piece of women’s pregnancy, and with the providers who care for them. reproductive health needs, and we believe that an ethical view that allows for later abortion is inseparable We trust women. When we see a woman in need of a from one that respects any aspect of a woman’s right later abortion we know that she is worthy of our to choose. support and respect. She should be able to trust that she is in the hands of a provider who will help make We believe that women are moral decision makers, her decision a reality. We believe that the right to and consider their options carefully when faced with an choose is grounded in respect for her decision and the unintended pregnancy. It is more important that a process and time it took her to make that decision. woman make the right decision for her and her family than that she make an early one. Women deserve to As advocates for abortion rights, we recognize the have all the time they need in order to make the best need for policies that address the full range of a pregnancy decision for themselves and for their woman’s reproductive needs, including maternity families, even if this means needing a later abortion.

20 conscience Later Abortion

Later abortion is something that many people find We trust women to make responsible choices for problematic—even those who support early abortion. themselves and their families. There is no reason to This is often because they think it is unnecessary, assume that any higher burden of justification is preventable and requested too frequently. None of required than for earlier procedures. these things is true. Specifically, we believe that we have a responsibility We believe that early and late abortions carry the to stand with each and every woman who seeks to same moral burden because we accept that all make decisions about her own reproductive life, like abortions end a potential human life. We further believe abortion, using the counsel of the professionals, friends that the moral responsibility of decision making, and family she chooses to involve. There is no debate whatever the gestation, should rest with women and about whether a woman is a person, a moral agent. their families, because only they can know their Women must be allowed and encouraged to make the circumstances and the results of their actions. decision that is right for them whether that is to become pregnant or to remain pregnant. Truly, women We are committed to explaining why later abortions are the only ones who can make the right decision for are necessary and why women and their doctors are themselves. This is the very essence of what it means to competent to make moral decisions and to act on them be prochoice. responsibly. This is not a matter of “messaging” or staying true to an abstract prochoice principle. It is SIGNED: because healthcare that does not include access to later abortions does not meet what women, and Advancing New Standards in Reproductive Health society, need. (ANSiRH) Association of Reproductive Health Professionals We believe that the provision of an abortion Black Women’s Health Imperative procedure requested by a woman in the second or Catholics for Choice third trimester is preferable to its denial, since the Medical Students for Choice denial of abortion has consequences for a woman’s life, National Advocates for Pregnant Women for the lives that are touched by her life and for the life National Council of Jewish Women Washington of the child that may be born. National Health Law Program (NHeLP) National Latina Institute for Reproductive Health We defend later abortions because we understand National Network of Abortion Funds that women need them, just as they need early National Organization for Women (NOW) abortion—and, indeed, just as they need contraception.

vol. xxxiii—no. 1 2012 21 So, Who Has Second-Trimester Abortions? By Rachel K. Jones and Lawrence B. Finer

abortion patients at 95 healthcare facilities across the United States. The study asked about age, race and how many weeks pregnant the woman was in addition to more sensitive topics such as exposure to domestic violence. The data are representative of all abortion patients in 2008. What did we find? Of the 1.2 million abortions that occurred in 2008, 121,000, or 10 percent, were in the second tri - mester, defined as 13th to the 26th week of gestation. We found several groups of women to be overrepresented among those having abortions at 13 weeks or later, including African-American women, teens, women with a lower level Data from the Guttmacher Institute’s 2008 Abortion Patient Survey revealed certain patterns to be found among of education, those using health insur- women who had second-trimester abortions. ance to pay for the procedure and those who had experienced multiple disruptive he overwhelming majority patients who have abortions after the first life events in the last year. For example, of abortions—88 percent in trimester. Given that second-trimester among black abortion patients, 13 percent 2006—are first-trimester abortions cost more than first-trimester terminated pregnancies at 13 weeks or procedures, occurring in or procedures and are offered by fewer later compared to 9 percent and 10 per- before the 13th week of preg- providers, it is likely that this group of cent, respectively, for white and Latina Tnancy. While research has established that women differs from the majority who has women. Among abortion patients aged women who have abortions have different the procedure earlier. To investigate these 19 and younger, 14 percent obtained traits compared to all women of reproduc- differences, the Guttmacher Institute abortions in the second trimester, a tive age—they are poorer, younger and recently undertook the first national figure significantly higher than the pro- less likely to be white—little is known study of women in the United States who portion among women aged 20 and older about the characteristics of the subset of have second-trimester abortions, the (10 percent). results of which will be published in a While our study did not examine rea- forthcoming issue of Contraception (and sons why these women were having an RACHEL K. JONES has been a senior research are already available online at http://www. abortion, we expect several conditions associate at the Guttmacher Institute since 1999. Her work there focuses on abortion and guttmacher.org/pubs/journals/j.contra- may contribute to this age pattern. It adolescent sexual health issues. ception.2011.10.012.pdf). may take younger women longer to rec- To conduct our analyses, we relied on ognize that they are pregnant; they may LAWRENCE B. FINER is the director of domestic research at Guttmacher. He studies the data from Guttmacher’s 2008 Abortion have a difficult time approaching a demography of unintended pregnancy and Patient Survey, which gathered self- parent or trusted adult to discuss the abortion in the United States. administered questionnaires from 9,493 pregnancy; or they may have more dif-

22 conscience ficulties finding an abortion provider or cost more than first-trimester proce - women—African-American women and coming up with the money to pay for the dures, women in these circumstances those with less education—would most procedure (especially if they are trying may be motivated to seek out informa- benefit from increased access to early to do so without involving an adult). tion about coverage as well as decide that abortion services. While expanded ser- Notably, while adolescents within the confidentiality is a secondary concern. vices could reduce the number of second- population of abortion patients were Women who experienced multiple trimester abortions, the need for such more likely to have a second-trimester disruptive events in the last year—such procedures cannot be entirely elimi - procedure, these young women only as being unemployed or falling behind nated. For one, diagnoses of fetal accounted for 18 percent of all abortions on rent—were more likely to have an anomaly and maternal health complica- and 24 percent of second-trimester pro- abortion in the second trimester. It is tions often do not occur until the second cedures. Thus, the majority of abortions, possible that these events lead to delays trimester. Additionally, some women including those in the second trimester, in recognizing the pregnancy as well as take longer to recognize they are preg- were for women aged 20 and older. delays in accessing services. Alternately, nant and to decide that they are going to Adult women without a high school some women who initially decide to have an abortion, while the decisions of degree had the highest proportion of carry a pregnancy to term may change others are influenced by changes in their abortions at 13 weeks or later (13 percent), their minds when confronted by an lives that occur after they find out they while women with college degrees had event such as losing a job or separating are pregnant. the lowest (6 percent). Again, we expect from a partner. For women needing second-trimester several dynamics may be at work. Less- Because with each additional week of procedures, having health insurance or educated patients may have less knowl- gestation abortions become more expen- other financial resources to pay for abor-

The higher cost and decreased availability of abortion services in later weeks make them less accessible to poor women and those paying out of pocket.

edge about reproduction and take longer sive and are offered by fewer providers, tion services is especially important. The to recognize they are pregnant. Simi- we wanted to see if there were differences average abortion patient pays $470 for a larly, they may have lower levels of health among the population of women first-trimester procedure, but the cost literacy and a harder time figuring out obtaining abortions at 16 weeks or later can increase substantially with each options, tracking down information compared to those at 13–15 weeks. The additional week in the second trimester. about abortion or finding a provider. only characteristic consistently and pos- Women who cannot afford to pay these Approximately one-third of abortion itively related to abortion at 16 weeks or increased costs out of pocket are then patients relied on either private health later was using health insurance to pay forced to carry an unwanted pregnancy insurance or Medicaid to pay for the for the procedure. In our more complex to term. As of January 1, 2012, 16 states procedure, and these women were more statistical analyses, once other factors had laws that limit abortion coverage in likely than those who paid out of pocket were taken into account, we also found health plans that will be offered in the to have an abortion at 13 weeks or later that women with the highest incomes upcoming health exchanges; eight of (14 percent vs. eight percent, respec - actually had a relatively higher likeli - these states have limited abortion cov- tively). Women who lack health insur- hood of having an abortion at 16+ weeks erage more broadly in all private health ance, or who have insurance that does compared to poor women. Taken to - plans they regulate. These restrictions, not cover abortion, may be unable to gether, these two findings suggest that especially if adopted by more states, are afford a second-trimester procedure. the higher cost and decreased availability likely to have a significant impact on Having and using insurance are two dif- of abortion services in later weeks make women seeking second-trimester abor- ferent things, however. Most women them less accessible to poor women and tions. And yet, the irony here is that the who have private health insurance do those paying out of pocket. growing number of restrictions on not use it to pay for abortion services, Prior research has found that the insurance coverage for abortion may perhaps due to concerns about confiden- overwhelming majority of second- paradoxically increase the need for tiality and lack of knowledge about trimester patients would have preferred second-trimester abortions by further whether abortion services are covered. to have had their abortion earlier. Our delaying women’s access to services early But because second-trimester abortions findings suggest that certain groups of in pregnancy. I

vol. xxxiii—no. 1 2012 23 Why We Need to Choose ‘Choice’ By Ann Furedi

hen we talk about politically divisive.... The fact that race Making a choice is, in itself, a demon- pregnancy termina- and class inevitably circumscribe one’s stration of a freedom of sorts—the freedom tion, some might say choice is ignored.” to influence and take responsibility for that the language of what happens next. Our lives are made “choice” is not helpful; This view of choice informs many in richer if we can direct them according to Wabortion is not a choice but a necessity. the Reproductive Justice movement. But our personal values and convictions—even Women do not choose to have abortions, it is one we should resist. The concept if our lives are not made richer by the the argument goes, they end their preg- of “reproductive choice” is as relevant options available to us. A “rock” and a nancies when they have no other options. as ever. “hard place” can be equally uncomfortable To say it’s a “choice” makes it sound as Traditionally, in our movement the even when you have chosen which to sit on. though a woman is deciding between a term “prochoice” has been shorthand for Law professor Emily Jackson spells it pair of shoes and a handbag. respecting an individual woman’s “right out like this in her book Regulating On face value, this sounds like a sen- to decide” for herself. And the inescap- Reproduction: Law, Technology and sible argument—both sound “mes - able question at the center of any discus- Autonomy (2001): saging” and an intelligent tactic. The sion about abortion, when everything else term “choice” evokes consumerism and is stripped away, comes down to this: can “The decision to have an abortion ... is the marketplace, after all, which have a woman be trusted to make her own made because, for a variety of reasons, nothing to do with abortion. We know decisions about her own pregnancy? this particular woman does not want to that women opt for abortion, not because This does not mean we ignore the carry a pregnancy to term. That she is they positively want the procedure, but very real issues of access to resources, not in control of these reasons should because they don’t want to be pregnant. services or the inequalities caused by not lead us to ignore her deeply felt We also know that more people are sym- socioeconomic conditions and the need preference. Even if we recognize that pathetic to abortion when they under- for structural change. It does not mean social forces may shape and constrain stand the real-life circumstances that that we ignore the impact of race or class. our choices, our sense of being the bring a woman to the clinic. So, should That there are limits on how indi - author of our own actions, especially we jettison the language of “choice”? vidual choice is exercised seems beyond when they pertain to something as Some feminist writers have argued that debate. People do not live in a vacuum; personal as reproduction, is profoundly we should. One of the louder voices no man—or woman—is an island. It’s valuable to us.” making a reasoned case against the lan- obvious to most of us that every personal guage of choice is Marlene Gerber Fried, decision (not just those concerning Making decisions is part of what it a respected activist and philosophy pro- reproduction) takes place within our life- means to be human. We may have no fessor who has argued for many years that context; the exercise of choice is limited control over what we “are,” in the sense framing abortion in terms of a woman’s to what is possible. What is possible for that our nationality and background right to choose is problematic. She claims: me may not be possible for you. Some- may be set, but we do have some choice times we make choices that we do not about what we “do.” Socially constructed “Because ‘choice’ appeals to those who want to make—but the decision falls to value systems do not predetermine all have options, but is relatively us nevertheless. Consider William Sty- the decisions we make. People in similar meaningless to those who do not, it is ron’s novel, Sophie’s Choice, in which a situations make different choices. The mother is forced to choose which of her abject poverty that drives one woman to

ANN FUREDI is chief executive of bpas, the children is killed. have an abortion may drive another to British Pregnancy Advisory Service, and author The point is this: life is full of decisions, place her children into social care. A of Unplanned Pregnancy: Your Choices. and it is who makes them that matters. diagnosis of Down syndrome may

24 conscience compel one woman to end her preg - Catholic or not, the Catholic hierarchy’s role in nancy, while another may decide to embrace the child as “special.” The fact influencing public policy affects you by limiting the availability that a woman is poor, or alone, or stig- of reproductive health services. matized clearly will influence her decision—but it does not take away her capacity to decide, to make a choice. On a fundamental level, if she has no capacity to make a choice in the matter it You can help us fight back takes away her humanity, since our against the Catholic hierarchy capacity to make decisions is part of what and secure reproductive healthcare and rights for all. makes us human. If our lives are simply dictated by circumstances, then we are no more than base animals—driven by instinct and environment. There is no ■ space for self-determination and no space Donate online by mail or phone for conscience because if we cannot or via employer matching gifts ■ planned giving choose what to do, then we cannot choose what is right and what is wrong. As Jackson says, “We cannot believe all our preferences are not ours without our sense of self effectively collapsing.” This is why the concept of “choice” is Whether you give so important. When we argue for a wom- a gift for now or an’s right to choose abortion, the argument is not just for the availability of a leave a legacy for clinical option but also for the right to use tomorrow, you help us her capacity to decide whether she will use preserve and extend it or not. We may not be able to provide women Catholics for Choice’s with the social and economic resources work to shape and to live their preferred lives. But we advance sexual and should not add to women’s burdens by refusing to acknowledge the importance reproductive ethics that of what they do have—what some people are based on justice, call “agency” and others call “decision- reflect a commitment making capacity.” To be prochoice is to say this: women, to women’s well-being whatever their background and circum- and respect and stances, are capable of making decisions. affirm the capacity of They do so every day. The decision to keep or end a pregnancy is one of these. women and men to Even though women’s choices are shaped make moral decisions by the constraints of their circum - about their lives. stances, they are tailored by their beliefs and their consciences. We cannot put aside our claim for women’s right to make reproductive choices any more than we can put aside our claim that women must be able to exercise the Learn more and help support our efforts: choice they have made. Whatever we call it—it must, in essence, catholicsforchoice.org/donate be a choice. I

vol. xxxiii—no. 1 2012 25 Lessons for the Prochoice Movement from the ‘Partial Birth Abortion’ Fight By Tracy A. Weitz

he fight over the procedure that came to be known as “partial birth abortion” spanned 15 years, beginning in 1992 with a presentation made Tat a clinical meeting of the National Abortion Federation and ending in 2007 with the Supreme Court upholding the Federal Partial Birth Abortion Ban Act of 2003. During this time, the opposition kevin kevin lamarque

destabilized the vision of abortion the / prochoice movement had framed in terms of rights, shifting the nation’s reuters focus to abortions done later in © pregnancy. Seeking to reclaim the President George W. Bush signs the “Partial Birth Abortion Ban Act” on November 5, 2003. Also pictured (from left) Rep. Bart Stupak (D-MI), Rep. Henry Hyde (R-IL), Rep. Steve Chabot (R-OH), House Speaker Dennis Hastert agenda, the prochoice movement chose (R-IL), Sen. Orrin Hatch (R-UT), Rep. James Sensenbrenner (R-WI), Sen. Rick Santorum (R-PA), Rep. James to focus on the women deemed worthy Oberstar (D-MN), Sen. Mike DeWine (R-OH) and House Majority Leader Tom DeLay (R-TX). of needing an abortion while shying away from the opportunity to increase delineating worthy activist who was aghast at what was being the public’s understanding of abortion as and unworthy women discussed. Information about the described a medical service. And buried in the In the talk that started it all, a physician technique spread quickly among antichoice ashes of this legendary battle are the from Ohio presenting at a national activists. After testing out several other stories of the real lives of the women who meeting of abortion providers described a names, the label “partial birth abortion” need abortions, as well as the potential procedure he called dilation and extrac- was eventually adopted as the public to advance quality healthcare. tion (d&x), now most commonly called descriptor—conjuring up images of fully intact dilation and evacuation (d&e). developed babies being killed in the process During the procedure the woman’s cervix of being born. TRACY A WEITZ, PHD, MPA, is an associate professor in the Department of Obstetrics, is dilated over several days so that the fetus In their responses to the attacks on Gynecology and Reproductive Health and can be removed fully after the skull is “partial birth abortion,” prochoice director of the Advancing New Standards in collapsed. Believing the audience to be advocates appeared disorganized and Reproductive Health (ANSIRH) program in the comprised of other physicians who perform uncertain about how to proceed. Some Bixby Center for Global Reproductive Health, abortions, his words were clinical and organizational spokespersons claimed both at the University of California, San Francisco. Dr. Weitz is also a board member of explicit in nature and clearly not meant for that the described procedure was rarely the American Civil Liberties Union of mass consumption. Unfortunately, the performed, attempting to separate the Northern California. meeting was infiltrated by an antiabortion abortion rights for which they advocated

26 conscience from the maligned technique. Others be found in the records of state legislative the truth, which is that women need abor- pointed to the statistic that over 90 per- hearings in Nebraska, Ohio and Idaho in tions throughout their pregnancies for cent of abortions occur before the end of 2009, 2010 and 2011. Lost during these reasons that reflect the complexity of the first trimester. After a series of state debates, as in the nationwide fight women’s lives. While public opinion polls shifting strategies, most advocates over “partial birth abortion,” is any focus continue to show limited support for later decided to focus on women whose wanted on the majority of women who need later abortions, prochoice advocates seem ill- pregnancies had gone horribly wrong and abortions (after 20 weeks of pregnancy). equipped to control the cultural conversa- thus needed an intact abortion procedure At the University of California, San tion and build, rather than simply defend, as a lifesaving intervention. These wom- Francisco, my colleague Diana Greene support for abortion rights in the United en’s stories were used to persuade Presi- Foster, PhD, is conducting a nationwide States. Prochoicers find it even harder to dent Clinton to veto a ban on “partial study of women seeking abortion in the talk about abortion as a medical service birth abortion” passed by Congress in US. She recently completed an analysis of rather than in legal terms. 1996 and again in 1997. (The act was even- the participants who were seeking abor- tually signed into law by President George tions after 20 weeks of pregnancy. (The shying away from W. Bush in 2003.) results were presented at the American explaining abortion On the occasion of the first veto, Pres- Public Health Association annual meeting Abortion is indeed a medical procedure, ident Clinton was flanked by women who in November 2011.) She found that almost but one that involves private and intimate aborted under the unusual circumstances three-quarters of the women fit one of six parts of the female anatomy and blood,

National advocacy groups seem to have no stomach for telling the truth, which is that women need abortions throughout their pregnancies for reasons that reflect the complexity of women’s lives. described above (less than seven percent profiles: women with babies under age mucus and other bodily secretions. The of all abortions are performed on women one; women who report difficulty fetus is usually removed in pieces using with wanted pregnancies). One woman deciding to have an abortion and also instruments and/or suction. None of these was holding a framed photo of the hand- experience logistic or financial troubles characteristics makes for pleasant dinner and footprints of her aborted child, dem- accessing abortion; young women who conversation. For years, prochoice advo- onstrating for the camera her sense of have never been pregnant before; women cates could avoid any discussion of the loss. In his veto message, President with a history of substance abuse and/or unpleasant side of abortion techniques, Clinton made a clear delineation between depression; women who report domestic pivoting instead to the horrific and graphic who should and should not have access to violence and conflict with their partner stories of illegal abortion. Consequently, the banned procedure. “I cannot support over whether to have an abortion; and when confronted with the “partial birth use of that procedure on an elective basis, women with a chronic health condition abortion” fight abortion rights activists where the abortion is being performed for and income below the poverty line. The were unprepared for talking about the non-health-related reasons and there are prochoice movement lost the opportunity medical realities of abortion. And when equally safe medical procedures avail- to build support for these women’s lives they did try to use medical arguments, the able…. There are, however, rare and and social circumstances and instead descriptions were often guarded, defensive tragic situations that can occur in a wom- focused on the few women whose abor- and disjointed. Court transcripts from the an’s pregnancy…. In these situations, in tions are deemed more acceptable. The early litigation against state “partial birth which a woman and her family must make women in the above categories have com- abortion” legislation are filled with an awful choice, the Constitution plicated lives whose stories take longer to awkward silences when lawyers and requires, as it should, that the ability to tell and require greater empathy on the witnesses searched for the appropriate choose this procedure be protected.” part of the listener. words and phrases. The discomfort Focusing on women with wanted preg- Today’s prochoice messaging clearly evidenced in the transcripts stands in nancies who end up needing abortions has delineates between worthy and unworthy direct contrast to the clarity with which become the subsequent go-to strategy for women in the same way that Clinton’s veto the issues were discussed in 2003 by the prochoice advocates fighting limits on message did. And national advocacy legal team and the witnesses assembled to later abortion. Evidence of this shift can groups seem to have no stomach for telling fight the Partial Birth Abortion Act. By

vol. xxxiii—no. 1 2012 27 lessons for the prochoice movement from the “partial birth abortion ” fight

that time, the medical community had death.... So I took her to the OR to basically members’ hesitation about advocating for explored the value of the intact d&e tech- do a d&e ... so I could get her to quit a healthcare intervention they weren’t nique and determined it to have several hemorrhaging. Well, you know the whole comfortable explaining. However, in clinical advantages over disarticulation thing about the partial birth abortion. failing to learn how to talk openly about d&e, which was not banned under the I mean, [it’s] being born breach, it’s still what abortions look like and why physi- Supreme Court decision. Lawyers found kicking, it still has a heartbeat, its head is cians might need to perform them, value in defending, not simply the rights stuck in her cervix. What would make sense prochoicers left the issue to be framed by of doctors to practice according to what would be to punch a hole in the back of its antichoicers. Prochoice advocates then they determine to be medically necessary skull, collapse its brain, get it out of there and countered by focusing not on the care for the patient, but in specifically rescuing save the patient. But you’ve got all these people women need but on the worthiness of the the legal legitimacy of the banned tech- in the OR that don’t know what the woman obtaining the care. This limited nique. The American Medical Associa- background situation [is].... And it’s just the movement’s ability to develop support tion, which had initially supported a ban like that would’ve made perfect sense to do for the majority of women who will need on “partial birth abortion,” subsequently that but I didn’t primarily because I was abortions later in pregnancy, women reversed its position and opposed setting worried that all these, you know, the techs and whose lives don’t fit neatly into the one limits on abortion techniques. The Amer- circulating nurses in the OR are going to box allowed for later abortions. ican College of Obstetricians and Gyne- think, ‘Oh, Dr. B. is a baby killer,’ you know, The House of Representatives is cur- cologists issued strong statements about ‘And she just did a partial birth abortion and rently debating legislation that would the potential harms the ban could cause to doesn’t everybody know that’s illegal?’” allow hospitals to opt out of providing women’s health. emergency abortion care (whether the Unfortunately, abortion rights advo- According the law, the intervention healthcare professionals in those hospitals cates outside of the medical and legal fields the physician described would probably want to or not). In order to successfully still lacked the skills with which to discuss not meet the standard for criminal pros- engage in this and subsequent debates, the abortion. After the “partial birth abortion” ecution since the provider did not prochoice movement will need to move debate, the take-home lesson for these “intend” to do an intact procedure, but away from attention to the worthiness of advocates was that talking about the details no case law has yet been written on the the patient in need of care. Instead, advo- of abortion was a losing strategy. The con- subject. And regardless of the letter of cates need to focus on the rights of all sequence of this avoidance is that the actual the law, the effect of the law has been to patients to obtain the most appropriate effects of the ban are hidden from view. create a surveillance system in which healthcare. The attention should be on My colleague Lori Freedman, PhD, is doctors feel watched, whether or not healthcare professionals being able to use studying the experiences of ob/gyns who they actually are. French philosopher all of their abilities and professional deliver reproductive healthcare in hospital Michel Foucault called this phenomenon resources and their right not to be limited settings. Some physicians whom she inter- the “Panopticon.” With this kind of sur- by either informal surveillance systems or viewed do not routinely provide abortions veillance, physicians make decisions in formal institutional policies rooted in and don’t consider themselves “abortion the operating room based on their fears politics, not medicine. To oppose laws that providers,” but nonetheless they have been about who might be watching, worried determine what kind of care a healthcare affected by the very existence of the “par- that onlookers will misinterpret the situ- professional can offer or that would allow tial birth abortion” ban. At a recent San ation. In this case, the physician was able institutions to decide not to take care of Francisco General Hospital Abortion Dis- to complete the disarticulation d&e and patients, advocates need to be able to share cussion Group held on January 17 of this the patient recovered, but these kinds of medical stories in ways that enhance rather year, Dr. Freedman presented the story of scenarios weigh heavily on the minds of than obscure the realities of medical care. one doctor trying to care for a patient who physicians who have the surgical skills to Abortions are socially complicated was losing a 22-week pregnancy due to rup- implement lifesaving interventions. and medically unpleasant to describe, as tured membranes. In writing this article, Their stories, however, are not told. the story in this article demonstrates, but I contemplated how much to edit the doc- These physicians are not monsters— advocates for abortion rights are best tor’s story and decided on modeling the rather they are focused on the health of served by acknowledging rather than approach I want advocates to take: allowing the pregnant woman. trying to ignore this dimension. The the real stories of women and providers to lesson from the “partial birth abortion” reach the general public. a renewed need for debate is not to move away from the con- an honest conversation versation but to lean into it, bringing Dr. B: “[The patient] was kind of in the The prochoice movement was unprepared multiple arguments to bear on all process of delivering but it wasn’t coming fast for the fight over “partial birth abortion,” women’s worthiness of the right to have enough and she’s trying to hemorrhage to in part because it was hindered by its own a safe abortion. I

28 conscience What Catholics Believe About Birth Control

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vol. xxxiii—no. 1 2012 29 Between a Rock and a Hard Place deciding about a pregnancy after a prenatal diagnosis of fetal anomaly By Jane Fisher image: image: wikimedia george commons: gastin A picture of chromosomes taken at London’s Science Museum.

“This was our baby that we had waited a long time for and the ince antenatal results and Choices ( arc) w a s decision was not made lightly. We had to think of our life too and founded in the UK in 1988, we have had contact with that of our families. What would happen after we died? Nobody thousands of women like S“Jill.” In our lifetime, we have seen a could love our child like we could. We had to let go, try to be rapid development in and implementa- tion of genetic testing technologies. unselfish. Perhaps many would say that this decision was not right, What has definitely not changed is the emotional impact on a parent who is told but we made it for what we considered the right reasons.” their baby has a fatal, life-limiting or disabling condition. After receiving the — “Jill” 2007 news that their baby is not developing as expected, parents then face the difficult

JANE FISHER is director of the UK charity arc (Antenatal Results and Choices). The organization decision about continuing or ending the provides non-directive information and support to women and their partners through prenatal pregnancy. I use the words “parent” and testing and its consequences. “baby” because this is the way women

30 conscience like Jill who come to us most often refer abilities and inroads made in constructing tions are few in number (according to to themselves and the fetus. a more inclusive and accepting society. At government statistics there are fewer I have spent 10 years with arc speaking the same time, antichoice campaigners than 200 post-24 week abortions per almost daily to women and their partners have seized the opportunity to attack the annum in England and Wales—0.1 per- before and after their decision to end a clause in the UK Abortion Act of 1967 that cent of the total) and the majority are pregnancy upon receiving a prenatal diag- allows for abortion if “there is a substantial carried out due to indications of serious nosis. This includes many for whom the risk that if the child were born it would fetal abnormalities that do not manifest unexpected news comes late in the preg- suffer from such physical or mental abnor- until late in the pregnancy. nancy. It is undoubtedly a traumatic life malities as to be seriously handicapped” This charged context can add an extra event and the psychological repercussions and called it “eugenic.” Antichoice advo- layer of difficulty for women and couples can be significant. But my experience has cates have attempted to enlist disability dealing with a diagnosis of fetal anomaly. reinforced my belief that in the face of a campaigners to their cause. The Society for They struggle with complex and often fetal anomaly, parents must be empowered the Protection of the Unborn Child (a conflicted feelings over ending the to make the decision that is right for them- small but vociferous UK antichoice orga- pregnancy while being fearful of the selves and their families. The vast majority nization) uses its website to accuse arc of judgment of those around them and in of parents arc supports regret that they being “actively complicit in the fatal dis- the wider world. I hope that by exploring

The vast majority of parents arc supports regret that they found themselves in such distressing circumstances, but do not regret that they had the choice to end the pregnancy.

found themselves in such distressing cir- crimination of disabled people enabled by the perspective of parents who come to cumstances, but do not regret that they legal abortion.” arc, it will be clear that they are not had the choice to end the pregnancy. It is a clever move by the antichoice denigrating those living with a disability, Rather than offer a polemic on the lobby, as they are aware that many who but making responsible decisions ethical justification for abortion in cases would class themselves as “prochoice” informed by their individual values and of fetal anomaly, I want to use our experi- worry that ending a pregnancy on the personal circumstances. ence at arc to let women who have had grounds of disability may devalue the such abortions provide insight. lives of those living with some sort of why women need access to impairment. Furthermore, when antiabortion beyond 20 weeks the political context choicers decry that those women who of pregnancy surrounding abortion for have terminations for fetal anomaly are Most developed countries now offer fetal anomaly in the uk pursuing perfection or taking the “easy prenatal screening and diagnosis for way out,” they know that it is rare for a major chromosomal disorders before the “I even envied women who had miscarried— woman who made this choice to speak first 14 weeks of pregnancy. This has been something I’d experienced myself, with great out publicly against such vilification. In facilitated by improvements in scanning sadness, three years previously. But at least such a deeply private and personal expe- technologies and testing techniques that those babies hadn’t died at their mother’s rience, most women understandably do now deliver an accurate early screening hands, and their experiences evoked straight- not want their circumstances put under result. This in turn enables women to opt forward sympathy, never vitriol.” public scrutiny. for chorionic villus sampling (cvs), an “Sara” 2011 The antichoice movement also readily invasive diagnostic procedure that can be It is worth pausing to consider the polit- exploits public squeamishness about late carried out from 11 weeks in order to ical context in which women now make abortions in the hope of restricting check for chromosomal conditions such decisions after prenatal diagnosis. In recent access. There are regular media flurries as Down syndrome. Early scans now years we have seen laudable gains made by around late abortions, in particular those produce images that are instantly recog- the disability rights movement. There have performed past the legal limit of 24 weeks nizable as a developing baby, even to the been legislative changes to combat dis- for non-medical abortions in the UK. untrained eye. Today most prenatal diag- crimination against those living with dis- The fact is that these post-24 week abor- noses of Down syndrome in England are

vol. xxxiii—no. 1 2012 31 made earlier in pregnancy as a result of Within seconds, all their hopes and parents have to make what they know are these technological breakthroughs. But dreams around the baby that they had life-changing decisions based on an it is important to understand that there envisaged are destroyed and many then emerging, but still incomplete, picture of is a limit to the diagnoses available at this confront the prospect of possibly ending the fetus. stage of fetal development. their pregnancy. deciding to end the pregnancy Having been reassured by first trimester screening, many parents approach “The 20-week scan brought the shocking “But how, as … a human being you make their mid-pregnancy anomaly scan (usu- diagnosis. We only spoke to the those sorts of decisions, you know, ‘Do I stick a ally performed at around 20 weeks) as an sonographer who faxed a referral to a needle in my baby’s heart and kill him now? opportunity to “see” their baby, perhaps fetal medicine department. I then had to Do I give birth to him and then sort of hope learn the sex and gain further reassur- wait from Thursday until the Tuesday to that he doesn’t die, have a heart attack and ance that all is progressing as expected. speak to someone. It was the worst few drop dead at the age of five, you know? Or, if While they may be aware that anomalies days of my life not knowing what was he survives it all, which is the best you hope could be detected, this will not normally going to happen—all I knew was that it for, how will he live with the burden of this be at the forefront of their thinking. was spina bifida and malformed brain. knowledge of this terrible incurable thing.… ?’ Some will invite other children and That 20-week scan has changed my “And I remember sort of going round in family members to be present in the scan life forever.” circles in my head between these things, and room to share the excitement. “Amanda” 2010 thinking, what am I going to choose, you

I have lost count of the number of women who have told me that they had always been antiabortion but suddenly found their position first challenged, and then ultimately shifting.

“So on the Friday morning we went to After the initial information, there are know? Which of these three just awful, very the hospital for the anomaly scan, and my usually further specialist scans and tests different scenarios is the one that I feel I could expectation of that was to be told that to confirm the diagnosis. Some parents live with, or that I could choose him to have to everything was fine, and find out the sex will be encouraged to wait to see how the live with?” of my baby. And that was, that was all condition develops. All this can mean “Melanie” 2008 I thought was going to happen, because there that they can find themselves close to, or couldn’t have been anything wrong because occasionally beyond, 24 weeks before “Melanie” powerfully expresses the everything so far had told me that everything being able to make a final decision to intense distress often inherent in the was okay. And even though I read the leaflet have a termination. decision-making process. It can feel like that said, you know, this condition and that There are some structural conditions, an impossible dilemma and many will condition and—none of it really sunk in.” particularly those affecting the fetal try, like Melanie, to work out what the “Val” 2011 brain, which do not become apparent least worst option is for them. We will until the third trimester. Thankfully, never have definitive information on When parents receive the news that these conditions are rare and can be exactly how women make these deci - all is not well, they feel as though their picked up by chance when a scan has been sions, but over the years at arc we have expectations are shattered. scheduled for other reasons, such as gained knowledge of the factors that par- “‘Everything is all right isn’t it?’ I said in checking placental position. Again, there ents weigh in the process. my innocence. It was then that he stopped the will be the need for further testing and machine; put his hand on my arm and stony sometimes careful monitoring to give as “There was no way I could go through the faced said, ‘No, I’m afraid it’s not. I think much prognostic information as possible. pregnancy and give birth only to hold my baby we need to have a chat.’ Sadly, while medical technology has made and watch it pass away. We also had to think “That moment and those words will great advances, clinicians’ ability to give of our daughter, the effect on her. She already remain with me until the day I die—my accurate or conclusive information about knew there was a baby in Mummy’s tummy blood actually ran cold.” the expected outcome is still limited, par- and loved putting her hand on the ‘little “Jo” 2010 ticularly early in the pregnancy. Thus, bump’ and talking to the baby. It would have

32 conscience between a rock and a hard place

been awful to go through the whole experience lenged, and then ultimately shifting. not legal at home. Some of them want to and then have to explain to her that the baby Those people of faith who choose to ter- express their gratitude to us for having wasn’t coming home.” minate can reconcile their decision with helped them access services and offered “Chrissie” 2011 their religion. They often conceive of a support so they could prevent the birth benign God who has given them the of a child with severe disabilities or who When the diagnosis is a lethal or life- opportunity to prevent their child’s suf- would not survive. limiting condition, for some women a fering. They take comfort from imag- ”The lady that scanned me first of all was termination hastens the inevitable and ining the baby at peace in heaven. very thorough. And if it hadn’t have been prevents more suffering for themselves, Some parents will make a decision for her, we would have never ever have their baby and other family members. quite quickly; others will struggle and known. And I would like to thank her and I When the condition is disabling rather vacillate before ultimately deciding to can’t remember her name but I would like to than life threatening, parents consider terminate the pregnancy. None will end thank her very much, because if she hadn’t how this will affect their child’s quality a wanted pregnancy easily; all know that pointed these things out in the first place, of life, the long-term impact on their the consequences of their decision will we’d have never have got to the specialist relationship, on their own individual stay with them. But those who do so have hospital. We’d never have had the lives and that of their families. said that for them the consequences will amniocentesis, and we would have never ultimately be less onerous than watching “I tried to shake away the image I conjured have known until the day he was born.” their child die or suffer after birth. in my head of a little boy, lonely and “Debra” 2010 The women whose words appear here friendless, robbed of the most basic human articulate the often painful nature of the functions. The prospect of watching a child The legal situation in Britain regarding decision to end a pregnancy due to fetal I’d love just as much as his sisters suffer in abortion is not perfect, but on the whole, anomaly. For many there will always be this way made me howl. I hugged my when a significant fetal anomaly is diag- a part of them that rails against being stomach, as if I could in some way shield him nosed, women are given the option of involved in their wanted unborn baby’s from the misery that lay ahead.” abortion. We have heard testimony from death. As we support women and their “Sara” 2011 enough women at arc to tell us that this partners in the aftermath of the proce- is as it should be and we will do our utmost “We had our other children to think of and dure, we see them contemplate the to ensure that this is how it stays. who would look after our child when we were extraordinarily demanding circum- no longer here. Also we are not very well off stances that were thrown at them. We financially.” see them make peace with having made The quotes in the article are all from arc “Petra” 2009 a decision that was emotionally painful, members and are taken from arc News, but right in their own individual context. our quarterly newsletter, with two “Petra” was concerned about the We see them integrate the experience exceptions. financial implications of bringing up a into their lives and move forward. It is The story from “Sara” appeared in the child with disabilities. It may feel uncom- particularly moving to hear from women Daily Mail on May 15, 2010. The quote fortable to consider economic factors but from Northern Ireland and the Republic from “Melanie” comes from HealthTalk there is no denying the reality that a of Ireland who have had to travel to Eng- Online.org’s web page “Making the child with a significant disability will land to have a termination because it is decision to end the pregnancy.” I need extra care, frequently requiring one or both parents to reduce their working hours. In these times of fiscal austerity GIVE A GIFT THAT LASTS A YEAR. in the UK, social care cutbacks have resulted in reduced access to services for Buy a gift subscription to those who cannot afford to pay for them. There are other considerations for some women and couples, such as the Conscience attitudes of close family and friends along with their own values and beliefs ONLINE AT www.conscience-magazine.org around abortion, sometimes informed by BY TELEPHONE AT +1 (202) 986-6093 their faith. I have lost count of the OR BY MAIL: send a check for $15 ($25 for non-US addresses) to number of women who have told me that they had always been antiabortion but Conscience, 1436 U Street, NW Suite 301, suddenly found their position first chal- Washington, DC 20009, USA.

vol. xxxiii—no. 1 2012 33 Who Pays the Piper? funding for contraception and abortion By Christian Fiala, MD, PhD

s human beings we are ongoing stigma against abortion, women far from perfect. This means are still forced to explain themselves and Abortion coverage and legality that accidents happen. Since accept insensitive or insulting behavior in Europe accidents are unpleasant from others around them, including experiences, we try to avoid unprofessional treatment from some them.A For example, to prevent traffic acci- healthcare professionals. dents, we make driving licenses obliga- We have made considerable progress tory, impose speed limits, limit alcohol over the last century, during which time use by drivers and make sure people women have gained much more respect these and other rules through autonomy over their bodies, including regular enforcement. These are all helpful their reproductive health. This shift strategies to reduce accidents. But some from paternalism to self-determination image: image: christian fiala accidents will still happen, so we need was a significant factor in the unprece- medical backup, everything from first dented improvement in women’s health aid, emergency call centers and ambu- and quality of life. But society as a whole lances, to specialized trauma units in has also profited from increased women’s ■ Abortion is illegal and done only exceptionally hospitals. Our modern societies have autonomy: the high standard of living for medical reasons or not at all established these prevention and medical that so many of us enjoy today is the (Ireland, Poland, Malta) ■ Abortion is paid for by social security at least backup services for all the contingencies result of the female population’s ability for some women (almost all Western Europe) of life. The approach of prevention and to actively participate in society without ■ Abortion is not covered by social security care has become standard—an important their lives and health being threatened although it is legal and being done (Austria and some Central European countries) cultural achievement. by illegal and unsafe procedures, or ■ No data But there is one exception: accidents repeated unwanted childbearing. as a result of sexual activity. If an unintended pregnancy occurs and the woman decides to have an abortion, she is sud- Coverage of costs for contraception and abortion in various European countries denly left alone. “It’s her own fault,” was a common reaction some decades ago. Country Contraception Abortion costs But we still act that way even though France most most most people don’t dare say it out loud Albania, Belgium, Germany, Italy, nowadays. Because of the implicit social Netherlands, Spain, Sweden, Turkey, some most expectation that women should carry Uzbekistan their pregnancies to term and the UK some some DR. CHRISTIAN FIALA is the medical director of Finland, Switzerland none most the Gynmed Clinic in Vienna, www.gynmed.at. He is an ob/gyn who earned a PhD at the Bosnia and Herzegovina most none Karolinska Institute, Division of Woman Child Health, in Stockholm. Dr. Fiala founded the Austria, Cyprus, Czech Rep., Hungary, Museum of Contraception and Abortion in Israel, Latvia, Russian Federation, Slovakia none none Vienna, www.muvs.org.

34 conscience However, the ancient double standard especially in wartime and during dicta- ristic concept of power and the new prevails in reproductive health. Women torships. To reach this goal, some democratic view based on individual are still burdened with all the con - imposed and continue to impose restric- responsibility and autonomy. To estab- sequences if they go against societal tions on contraception and abortion. lish the latter, we need to extend our expectations and decide they don’t want The debate about covering costs for social consensus on free healthcare for to get pregnant or stay pregnant. For contraception and abortion has little to all to include easy access to free contra- example, women often have to pay out do with facts or reducing the number of ception and abortion services. These are of pocket for basic preventive measures abortions. It is about personal beliefs not luxuries or elective services—they and for the medical treatment of and forcing others to conform to one’s are the very basis for achieving a high unwanted pregnancy. own belief system. It is a remnant of the standard both for women’s health and for We seem to have forgotten why the ancient struggle between those holding society’s well-being. I so-called developed countries got to power and the individual’s desire for self- where they are today. One of the main determination. It is a struggle between Acknowledgement: The author thanks reasons is our social consensus that it is two competing social ideas: the milita- Joyce Arthur for contributing to this report. in the interest of the whole of society to help individuals prevent accidents and to care for them if an accident does occur, regardless of the reason or the person’s Abortion Cost and Coverage: social status or income. This concept of A Cross-European Comparison helping individuals instead of letting them fend for themselves is well- By Christian Fiala, MD, PhD established in many countries. Most European countries have extended this Despite the great attention society pays to abortion practices, little is known about the social compassion to reproductive health economic aspects of abortion. The medical, psychological, political and legal facets of and coverage for the costs of contracep- abortion are frequently and thoroughly examined within an international context, but tion and abortion with social security, at there remains a lack of comparative data on the actual costs of abortions. To arrive at least in part (see table). an understanding of abortion costs in Europe, a 2005 study conducted by Christian However, this is not the case in a Fiala, Sophie Hengl and Chantal Birman collected reproductive health coverage and number of countries. Even in those national health plan refund policies across the continent. places where reproductive health is This information was gathered through questionnaires sent to abortion providers, covered, abortion coverage is under gynecologists, hospitals, family planning centers and healthcare organizations, constant threat. asking about contraception and abortion coverage through public assistance; the The reluctance to apply evidence- out-of-pocket cost for women; and access to different methods of abortion. The cost based medicine to reproductive health of abortions in each country was interpreted relative to the per capita indicator of the reflects a preference for traditional or Gross Domestic Product (gdp)—that is, to the country’s economy overall. religious beliefs over historical experi- The data revealed that abortion costs vary considerably throughout Europe, ence and facts, because it’s difficult to ranging from free to 517. The line between reimbursement strategies can be understand from a rational point of view. drawn roughly between East and West. Most countries in Western Europe provide a The health and social benefits of cov- full or almost-full refund to the majority of women who have an abortion. In ering contraception and abortion are contrast, most women in Eastern Europe, as well as in Austria, bear the cost of clear—it saves women’s lives, improves abortion alone. And there are still a few countries where, due to pressure from the their health and that of their families and Catholic hierarchy, legal abortion is either nonexistent or impossible to access: allows them more chances to fully par- Ireland, Malta and Poland. ticipate in society. Though abortion is legal in most countries across Europe, the affordability and Unfortunately, the debate over abor- accessibility of the procedure vary sharply from place to place. The varying economic tion coverage does not take place in the conditions related to abortion seem to reflect an “evidence-free zone,” meaning that realm of evidence-based medicine. policy and practice are often decided by ideological considerations rather than a Instead, the conflict is part of the centu- concern about women’s well-being. Engagement on two fronts is needed if we really ries-old fight between those in power and care about the health of women: the application of evidence-based medicine in abor- individual citizens who want to decide for tion care, as well as joint international efforts to further improve the healthcare themselves. Political leaders have some- systems that deliver such care. A commitment to women’s reproductive health across times sought to increase their population the board would level out many of the differences we currently see in abortion poli- for military or nationalistic purposes, cies across Europe.

vol. xxxiii—no. 1 2012 35 Contraception: My Health, My Conscience, Our Freedom By Jennifer Becker-Landsberger

ne could say i have always wanted to be Cath- olic. I was raised in a

non-practicing Methodist household. At least twice a Omonth, though, I would sneak off to the Catholic church—during off hours— and sit in the silence and admire the beauty. The intricate carvings, the candles burning steadily and the smell of incense all combined to form a sense of holiness and presence that I still love. When I became engaged to a Catholic gentleman, I began the process of con- verting to Catholicism. We were married in the Catholic church by an extremely nice priest who didn’t berate us for living together prior to the wedding. As a hap-

pily married Catholic couple, we had to of image courtesy of library francis medicine, a. countway medical harvard school immediately deal with the fact I was on Engineer Gilmore Tilbrook patented his “Rhythmeter for determining sterility and fertility” in 1944. six different medications for my bipolar disorder. My doctors have made it clear that, for the health of any future child or considerations mean that, realistically, my medical situation. My husband and I children, I would have to be on different pregnancy is not an option for me. met with a lady, whom I’ll call Nancy, medication or none at all for at least six My husband is on active duty with the who had gone through the required nfp months before trying to get pregnant. I Navy, and after our marriage we were classes and certifications and was highly would also need family members to stay transferred to South Carolina, where we recommended by our priest. with me during the pregnancy. These immediately found a new church. I The two initial nfp classes taught me scheduled an appointment with the more about the female reproductive JENNIFER BECKER-LANDSBERGER is a freelance priest and he assured me that natural system than I ever learned in school. For writer who publishes religious and travel family planning (nfp) was the way for us the first two months we were abstinent, articles. She is a member of mensa, has a degree in history and does volunteer work for to go. He said that there was no need to as required for the initial charting. It Kitsap County hiv/ aids Foundation and in violate the ban on contraception and we seemed like a small sacrifice in our mar- support of fellow military spouses. could still act responsibly in regards to riage for the state of our religious well-

36 conscience being, which was important to us both. while some women may believe the mis- iuds—can induce abortion. Hormonal During the two-month period, we went information out there, many are dis - contraceptives help prevent pregnancy by to two additional appointments with missing it. A recent report from the three means: preventing ovulation, thick- Nancy, learning more about the natural Guttmacher Institute showed that only ening cervical mucus to make it harder family planning method. Despite the two percent of sexually active Catholic for sperm to reach the egg and by thin- fact we’re fairly intelligent (my husband women, even regular church attendees, ning the lining of the uterus. But the is a chemist and an engineering labora- rely on natural family planning. The fringe of the antichoice movement argues tory technician; I’m also a former other 98 percent have used birth control that pregnancy starts the moment sperm chemist and current Mensa member), we methods banned by the Vatican at some meets egg, forming a zygote. By this fell for Nancy’s claims that nfp is 99per- point in their lives, with 70 percent cur- logic, if any woman with a fertilized egg cent effective without doing any double- rently using the pill, sterilization or an is pregnant, then a contraceptive that checking. After all, a lady in the employ iud. This is not a surprise, since the prevents pregnancy after the point of of any church wouldn’t lie. Then I World Health Organization states that fertilization is actually causing an abor- attended appointment number five. natural family planning is only 75percent tion. However, the American College of Nancy told me that the birth control pill, effective, not 99 percent as we were told. Obstetricians and Gynecologists (acog) which I had used for five years, had prob- A year later, we’re using birth control holds that a pregnancy is not established ably caused me to have multiple abor - pills again, since our three options until a fertilized egg is implanted in the tions without me realizing it. according to the Catholic hierarchy are: lining of a woman’s uterus.

Our priest’s insistence that natural family planning was the only moral decision caused me to fear his possible reaction—particularly in light of the fact that I was not planning on “repenting” of my sin.

I sat there speechless. I believed her for 1) use natural family planning and run a This question is not just nitpicking about 10 seconds, and then the part of my serious risk of getting pregnant and over definitions. The argument that cer- brain that uses reason spoke up. It said causing harm to the fetus; 2) abstain from tain contraceptives cause abortions has plainly—and thankfully, silently—a skep- sex all together and run a serious risk of been used by some pharmacists to refuse tical word that a nice, religious young lady ruining our marriage; or 3) violate the to fill prescriptions for birth control, shouldn’t say. I smiled sweetly, sat through rules laid down by the Vatican and use thereby denying women prescriptions the rest of the appointment, and left. “real” birth control. Also a year later, I’ve that are not only legal, but prescribed by Upon reaching the house, I got on the become aware of a movement, disguising their doctors. It is fundamental to the computer and started researching. My itself under the banner of morality, question of contraceptives and women’s initial web search brought up a variety of attempting to take away the option to use right to use them. sites agreeing with Nancy that I had unin- many forms of birth control. This move- Those who object to birth control tentionally killed multiple babies, but I ment is trying to force us back to the era either for religious reasons or based on was still skeptical. when women faced with choices about faulty science are actively working on the Then I adjusted the search parameters contraception, pregnancy and neces- political front to change laws and regula- to pull up scholarly articles, published sary—even lifesaving—medications had tions so that women no longer have the news articles and results from educa - fewer options than they do today. option of choosing some forms of birth tional sites. To my relief, I found out that control. Several states have attempted to taking hormonal birth control does not contraceptives do not pass sweeping pieces of legislation cause abortions. But my curiosity was cause abortions claiming to protect “personhood,” which aroused. I wondered how many other What was told to me in a church-sanc- is defined as beginning at the moment of women were being told this. I also won- tioned class can be heard elsewhere: that fertilization. This move is being promoted dered how many did a general web search, any woman using a hormonal method of most heavily by an organization going by believed the results of the first five sites birth control—including oral contracep- the name of Personhood usa, though that a search engine pulled up, and tives, Depo-Provera and Lunelle shots, many other groups are aiding the battle. stopped their research there. Luckily, NuvaRings, Ortho Evra patches and The Mississippi version of the amendment

vol. xxxiii—no. 1 2012 37 contraception: my health, my conscience, our freedom was defeated during the November 2011 supported the measure. The major media This oversimplification misleads many election, but the similar movements in networks, including cnn, consistently who would vote against it if they were other states are causes for concern. Well- referred to the amendment as an “abortion privy to the full story, which is that this known politicians, including both parties’ ban,” completely ignoring the various amendment would also outlaw many nominees for governor of Mississippi, other fields the amendment would affect. forms of birth control as well as in vitro fertilization.

dissenting opinions The misconception that using a contraceptive is the same as having an abortion may be distressingly common at church, in politics and online, but there is hope. Men and women, once informed about Check Out the full scope of this issue, often express a dissenting point of view. They spread good information to those they know. Our Website They vote. And they let their church leaders know that they, the laity, are where you’ll find the considering the moral implications of these questions. But are church leaders latest information on listening? And are all of the laity brave enough to share their opinion? progressive, Catholic, I must admit with sadness that, thus prochoice issues. far, I have not been one of the brave ones. Once back on regular birth control and more informed about its effects, I avoided I Stay up to date going to confession. Our priest’s insistence that natural family planning was with our activist the only moral decision caused me to fear his possible reaction—particularly in awareness campaigns light of the fact that I was not planning on “repenting” of my sin. Having not I Keep tabs on gone to confession, I felt guilty about taking part in the Eucharistic celebra- opposition groups, tion, specifically the actual taking of Communion. Our church attendance the religious right, and became less frequent. We’ve recently moved again—as I the Catholic hierarchy said, my husband is active duty military. Three months in our new home and we I Read articles from still haven’t visited our local church. I cannot speak for my husband’s reasons; the latest Conscience I can only share his actions. My con - science has been bothering me, and writing this essay has helped clarify my I Check out and order the latest feelings. At this point I am gathering my courage: I love my church and shouldn’t CFC publications avoid it out of fear. I plan on going to confession and hearing the priest out. And unless he f latly forbids it, I also plan on taking Communion. Because I am morally sure, in my heart, that for me, www.CatholicsForChoice.org this is the proper decision. I

38 conscience book reviews

done. It dives into the clerical culture and In Spite of the Hierarchy: provides examples of arrogant clericalism on the part of complicit hierarchs. The Understanding section on what is best termed “lay clericalism” dovetails well with the preceding Clergy Sexual Abuse chapter on societal endorsement of abu- sive behavior towards children. One of By Thomas P. Doyle, jcd, cadc the primary causes underlying the widespread abuse has been the reprehensible tendency of secular society and many Catholic laity to react with either denial The Dark Night of the Catholic Church Brendan Geary and Joanne Marie Greer (Editors) or minimization. ( Kevin Mayhew, Ltd., 2011, 620 pp.) The chapter titled “Religious and Edu- 978-1848673854, £34.99 cational Cognitive Distortions Used by Clerical Child Sex Abusers” is a fascinating contribution and one that is long overdue. The author provides lucid expla- his book is one of the very cating and Preventing.” The first section nations as to why abusers often appear to few written about the clergy attempts to present answers to basic ques- justify their behavior, sometimes using abuse issue that provides tions about why clerics molest children, theological concepts. This section goes scholarly articles about the key the effects on the victims and, most into some of the cognitive distortions and aspects of this complex and importantly, the contribution of the insti- toxic belief statements of those who Thighly controversial subject. One of tutional church and secular society to the oversaw clerics. The chapter proves the its more valuable aspects sexual abuse phenomenon. necessity of further study of the cognitive is the objectivity of The dimension of the distortions of the hierarchy since these the contributions. This abuse scandal that has are, in many ways, more important to the objectivity is remarkable captured the greatest thorny task of arriving at credible answers because, out of 25 chap - share of attention and for the bishops’ behavior. ters, including an intro- emotion has been the Although the behavior of the hier- duction and conclusions, question of causality— archy has somewhat overshadowed that by 18 authors, nine of the not “why do clerics sexu- of the predators, there is also a pressing authors are clerics or ally abuse minors?” but need to examine the internal makeup of members of Catholic reli- “why did the church allow the clerics who abuse. This subject is gious communities. All it to happen?” This latter explored in two chapters that do an contributors are profes- question is directed not at excellent job of summarizing a vast sionals with impressive the wider church, but at amount of literature on the subject. credentials and experi- the leadership, namely the The only weak chapter of the section ence. The Dark Night of the popes throughout the is chapter 8, which deals with the abuse Catholic Church is not presented as an ages and the bishops. The first chapter of faith, or the effect of clerical child sex apology for the institutional church’s provides a concise historical overview of abuse on victims’ faith. The author did efforts to confront the pandemic of abuse the church’s official responses beginning an admirable job in presenting the basic worldwide, nor is it a polemic against the with the Didache of the first century and issue and the initial symptoms or mani- responses of the Vatican and the bishops. culminating with a very brief summary festations of a damaged belief system. It succeeds fairly well at its aim to be a of the 20th century. The chapter con- The fault lies not with the writer of this source of information about clergy abuse. cludes with the thoughtful statement chapter but with the fact that very little The book is made up of 25 chapters that, with few exceptions, “the church research and writing has been done on divided into four parts: “Understanding,” does not understand the damage that the spiritual trauma following the sexual “Listening,” “Responding” and “Edu- abuse does to children.” Other chapters violation of a child-believer by a cleric. in this section explore how society in At the center of the collection are five general and the Catholic hierarchical chapters that make up Part 2, “Lis - THOMAS DOYLE, JCD, CADC, is a canon lawyer and was ordained a Catholic priest in 1970. system in particular have contributed to tening.” Here we find the three most He has been a supporter and voice for clergy child abuse. The chapter on the contribu- powerful contributions to the book: sexual abuse victims for over 25 years. tions of the hierarchy is especially well chapters by Colm O’Gorman, Marie

vol. xxxiii—no. 1 2012 39 Collins and Bishop Geoff Robinson. well as religious brothers and priests. Lay reported to civil authorities. This is hard O’Gorman and Collins are articulate people are not only shocked and hurt by to swallow in light of the blatant state- and wise survivors from Ireland whose incidences of abuse, but the existence of ments of several curial cardinals courageous efforts in the campaign for an abuser close to home has a painful insisting that bishops should not report recognition and justice for themselves impact on their overall faith in the accused priests. The chapter on canon and all survivors have been foundational church. This chapter also helps dispel law is about what should be done, not in shaping the remarkable course the two erroneous notions: first, that every what has been done. The latter is a sub- abuse scandal has taken not only in Ire- priest and religious not directly involved ject that merits its own study. land but throughout the world. Bishop must have been aware of the incident and The final section is about “Educating Geoff Robinson of Sydney, Australia, is helped cover it up. The second miscon- and Preventing.” This is the most theo- one of three bishops known to have ception is that the majority of those not retical area in that it speaks about the stood up publicly in support of abuse directly involved with the crisis are both “charism of celibate chastity” and victims and in criticism of the Vatican’s supportive of the disastrously inadequate “teaching human sexuality in a ministe- inept response. He begins his contribu- responses of the bishops and defensive rial formation course.” Both are eloquent tion by saying “What follows is my per- about priest and religious perpetrators. phrases, but in light of the consistent sonal story.” His personal story, The third section, “Responding,” failure of mandatory celibacy over the however, is far more than an autobio- departs from the standard descriptions past 20 years they betray an obvious dis- graphical sketch of his connection with of treatment modalities or complaints connect with reality. The chapter on the victims. It is an incredibly coura - about the hierarchy. The first chapter policies and procedures (Chapter 23) is an geous witness to the painful truth that addresses immediate interventions with exposition of the environment in which

Lay people are not only shocked and hurt by incidences of abuse, but the existence of an abuser close to home has a painful impact on their overall faith in the church.

must be found in the equally painful child victims, always a vital step in the policies are created rather than an search for the cause of the nightmare healing process. Two chapters describe attempt to present the various policies as that has plagued the People of God. The psychological treatment and spiritual the answer to the problem. The author pope and Vatican officials, as well as healing of abusers, while the final seg- offers some very realistic observations every bishop, must look within the ment is a description of the role of canon about the challenges involved in putting church for the antecedents of the abuse, law in dealing with abuse. effective programs into place. It is an rather than doing what the Vatican con- This last chapter serves as a straight- excellent chapter which might have been tinues to do—seek reasons outside the forward description of the available pro- better with a summary of the problems church upon which to place blame. cedures and not an in-depth critique of encountered with the application of var- The second section contains a valuable the failure of the church’s legal system. ious policies, noteworthy among them contribution by an anonymous priest- The fact that the author chose not to take the lack of support from bishops. abuser. There are few such written his analysis to this level is illustrated by The Dark Night of the Catholic Church accounts. This one is autobiographical certain assertions based on the text of the is a very valuable book. One hopes it will but not an “apologia” intended to defend law isolated from practice. One is that the prove to be a catalyst to more intensive, his actions. The writer shares his journey best interests of the child are of prime extensive and fearless research into this after exposure and provides needed per- consideration in canon law. This is true complex issue. Thus far the official spective into the life of an abuser who only on paper, since history has amply church on the Vatican and local levels benefited from both therapy and incar- demonstrated that the opposite is true of has avoided serious, objective research ceration. His story puts a human face on the way canon law is usually applied. into the many dimensions of clergy at least some clergy abusers, moving them The other glaring inconsistency abuse. This book proves that scholars from the category of inhuman monsters between canon law as written and as affiliated with the church have the capa- to deeply flawed offenders who are applied by the hierarchy is the matter of bility and sensitivity to advance into capable of some degree of redemption. reporting offenders to civil authorities. unknown areas. The lesson from a The final chapter is titled “The Voices The author of this chapter naïvely claims quarter century of experience is that of Secondary Victims.” It offers insight that the Holy See’s practice and position research will take place in spite of and into the reactions of active laypersons as is clearly that allegations must be not because of the hierarchy. I

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account suggests that this can be best Politics and Science: The understood as a case of willful ignorance, given the controversy that has always Tortuous Road for Emergency accompanied anything to do with contraception in the United States. (The Contraception in the US author offers a quite powerful indication of this controversy when she points out By Carole Joffe that in 1980 there were nine US pharmaceutical companies involved in contraceptive research and development, but by 1990 the number had fallen to only The Morning After: one, Ortho Pharmaceutical). A History of Emergency Contraception in the United States Heather Munro Prescott Given the avoidance of the topic in (Rutgers University Press, 2011, 184 pp) mainstream reproductive health circles, 978-0-8135-5162-3, $22.95 it is very moving to read of the tireless efforts of the early crusaders to dis - seminate knowledge about EC, some of whom remain active to this day. James he morning after: a Obama administration too has let “poli- Trussell, today a professor of economics History of Emergency Contra- tics trump science” when it comes to EC, at Princeton University and a member ception in the United States as the painfully familiar phrase connected of the interdisciplinary group that has begins by detailing the long, with that saga goes. In December 2011, produced numerous versions of Contra- tortuous road that Emergency after this book had gone to press, Kath- ceptive Technology, the “bible” for family TContraception (EC) followed to normal- leen Sebelius, Obama’s Sec retary of planning clinics, started his advocacy ization in the US, with a Health and Human work on behalf of contraceptive educa- particular focus on the Services, made the tion while an undergraduate in the dismaying behavior of the unprecedented decision 1960s. He later wrote some of the first Food and Drug Adminis- to overturn the fda’s influential papers on the potential of tration (fda) during the approval of allowing Plan emergency contraception to prevent George W. Bush presi- B, a dedicated EC prod- unintended pregnancies, including dency. Toward the end of uct, to be available with- some in collaboration with the late Dr. the book the author offers out a prescription to Felicia Stewart, a renowned specialist a note of cautious opti- women under the age in women’s health. Trussell was also a mism, pointing to the of 17. pioneer in providing information about “more progressive leader- Prescott’s well- EC on the web, once that technology ship of the fda” appointed researched, well-written became available. by President Obama. history starts in the 1960s, Prescott also mentions Dr. Stewart’s Indeed, fairly early in the with the emerging recog- practice of providing “do it yourself” Obama presidency, as nition among some EC kits for her patients, which con - Prescott reports, the fda did approve, in reproductive scientists and clinicians that sisted of cut up packets of regular oral an efficient and professional manner, a larger than normal dose of oral contra- contraception, along with typed ellaOne, a newer version of an EC ception used after unprotected inter- instructions as to how and when to use product. But of course, as readers of course was effective in preventing these pills for back-up contraception. (A Conscience are undoubtedly aware, the pregnancy. Significantly, though this surprising omission in this otherwise knowledge apparently soon became thorough book is any mention of Stew-

CAROLE JOFFE is a professor emerita of known in many college health centers art’s tenure as Deputy Assistant Secre- sociology at the University of California, Davis, and some rape units in police depart - tary for Population Affairs in the and a professor in the Bixby Center for Global ments and hospitals, it did not cross over Clinton administration, a position in Reproductive Health at University of California, into the knowledge base, or practice, of which she strongly advocated for San Francisco. She is the author of Dispatches mainstream medicine. Prescott gives no approval of a dedicated EC product.) from the Abortion Wars: The Costs of Fanaticism to Doctors, Patients and the Rest of clear answer to this question of why Thanks to the efforts of these pioneers, Us, and Doctors of Conscience: The Struggle to “postcoital contraception,” as it was once and others, particularly the Reproduc- Provide Abortion before and after Roe v. Wade. called, remained so unknown, but her tive Health Technologies Project, by

vol. xxxiii—no. 1 2012 41 Bookshelf Women and Redemption: A Theological History 1998 the drug Preven became the first Rosemary Radford Ruether (Fortress Press, 2012, 328 pp) fda-approved EC product. The book helps unearth the lives of historical women and men and their many paths Subsequently, a different EC product, towards redemption. This is a much-needed affirmation of a tradition many Catholics Plan B, became the center of a political sense lies just out of reach within the more frequently told stories about Catholicism. firestorm during the George W. Bush St. Thomas Aquinas, whose many contributions have been discussed in other presidency. The makers of Plan B asked publications, is revealed to have been a key architect in the imposition of systems that that the fda approve “over the counter” impose an inferior status on women in the church, which continues to stymie reform- (otc) status for the drug, arguing that minded Catholics today. ample scientific evidence demonstrated The second edition of this work builds upon the first version, published in 1998. the safety of such a move. This applica- The additions to the original material include: timelines for each chapter, suggestions for tion was subject to numerous delays and, further reading and research, as well as a focus on what the author calls the “Fourth predictably, the vociferous opposition of World.” This Fourth World is a postcolonial view that encompasses stateless peoples, antiabortion forces, but finally was indigenous groups and marginalized social and sexual minorities. The author examines approved by the joint advisory com - the feminist critique developed by each of the four “worlds,” in which “redemption” is mittee of the fda in 2003. Nevertheless, often understood to include critiques of existing structures related to race, class and in an unprecedented action, Steve Galson, colonialism. The book focuses on the 2000 years of the Christian tradition and a broad the acting head of the fda’s Center for selection of its many antecedents and offshoots. Jewish, African, Protestant and Catholic Drug Evaluation and Research, rejected views are incorporated into this work. the recommendation of the advisory The section on 12th-century mystic Hildegard of Bingen depicts the tension between committee. He argued that Barr Labora- this prophetic woman and her self-image as a “poor little female figure.” She broke new tory, the makers of Plan B, had not shown ground for women in her day, but she didn’t see her role as transforming social norms. that “young adolescent women” could Instead, the outspoken visionary saw existing male and female social roles as supporting safely use the drug “without the supervi- the rightful domination of men over women. Hildegard believed the worldly differences sion of a practitioner.” As Prescott points between men and women were not without remedy, but she saw social classes as being out, this was the first time that the fda much more rigid: only noblewomen were allowed to join her monastery. had ruled that a drug be assigned a pre- As the book moves through time it reveals a tradition of female spiritual seekers scription status based on age. Barr Labo- that was never truly obscured by the many voices that had a better platform within ratory resubmitted its application, established religion. Solid scholarship and the true historian’s gift at getting inside including data that demonstrated the long-vanished heads make Women and Redemption a worthy read. drug could be safely used by adolescents, but the fda repeatedly postponed its Church Militant: decision over the next two years. This Bishop Kung and Catholic Resistance in Communist Shanghai postponement, widely believed to be Paul P. Mariani, SJ (Harvard University Press, 2011, 282 pp) driven by the Bush administration’s desire Like history itself, this book can be read on a number of levels. As a Jesuit writing to please its social conservative base, led about a nation whose Catholicism has been heavily influenced by that order, it’s to the well-publicized resignation of Dr. understandable that the author is telling the story from a step or two closer than one Susan Wood, head of the fda’s Office of would expect from a history book. The result is anything but dry: rather, it is a well- Women’s Health. Not until Senators researched and well-told narrative that has the tone of a book about war. It has all the Patty Murray and Hillary Clinton made tragedies, tactical maneuvers and heroism one would expect about a conflict between good on their threat to hold up the con- two great enemies, one of them with a clear moral ascendancy, with the part of heroes firmation of a new head of the fda did the played by Catholic clergy and laypeople resisting government repression. agency finally release its decision in 2006: That Chinese communism was a political regime with an expressed enmity for approval for over-the-counter status was religion, especially Catholicism, and that many faithful people paid a high price in that granted, but only for women 18 and older. system, is clear from the author’s painstaking research. Even those readers who are less Later a judge ruled that this order had to likely to take sides with the way the Catholic church has interacted with secular powers also encompass women who were 17. in the last century will find Bishop Kung a compelling read. The battles Chinese Catholics Advocates again pushed to extend this were forced to fight against the government also drew in Catholic missionaries and the ruling to those under 17, leading to the secular and religious powers from their home countries, meaning this segment of history Obama administration’s overturning of was not two sides, good versus evil, but the complex interactions between a variety of the 2011 fda decision mentioned above. secular and religious entities. This book illuminates a new section of the sprawling and Most readers of this book will prob- complex tapestry woven by Catholics as they engage with the world—as missionaries, ably already be aware of the two main faith communities and sometimes as dissidents. opponents in the enduring conf lict over

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EC—on the one hand, antiabortion forces, who have relentlessly argued that Body Building: EC itself is an “abortifacient,” and on the other, reproductive health advocates Intervention in Evolution wishing to extend women’s contraceptive options. A particularly valuable con- By Gail Grossman Freyne tribution of this book is Prescott’s tracing of the internal dynamics and shifting alliances within the reproductive health community. In this regard, Embryo Politics: Ethics and Policy in Atlantic Democracies it is fascinating to note the counterin- Thomas Banchoff tuitive nature of the positions held by (Cornell University Press, 2011, 272 pp) some of the main actors: the physicians 978-0-8014-4957-4, $35.00 who pushed for the demedicalization of EC by advocating for otc status and freely handed out prescriptions of the drug to participants at the gigantic 2004 few short years before Banchoff does not fall prey to the March for Women’s Lives in Wash - the turn of the century allures of science fiction and he avoids ington, versus some of the best-known Dolly the cloned sheep was sensationalism, but his book is sensa- feminist health organizations, such as born. “It’s unbelievable,” tional. It is an exciting read and should the National Network for Women’s said Princeton geneticist generate a great deal of public interest Health, which were initially wary about LeeA Silver in a 1997 New York Times because it sets out with clarity the many making EC available over the counter article titled “Science strands, both ethical and due to concerns about safety factors and Reports First Cloning political, that make up in the fact that insurance programs typi- Ever of Adult Mammal.” vitro fertilization (ivf), cally do not cover non-prescription “It basically means there stem cell research and drugs. Eventually, as Prescott concludes, are no limits. It means all cloning. The author “Emergency contraception has served as of science fiction is true,” takes us on a journey a bridge issue that has brought together Silver continued. That through space and time: former adversaries, including feminist may seem like an oxy - across four countries health organizations, population and moron, but the same during four decades. The family planning people and groups rep- article features another countries are the United resenting women of color.” medical expert musing Kingdom, France, Ger- Even without knowing about the latest about an idea he’d once many and the United setback to EC that occurred during the had for a fictional tale States. In 1968 the first Obama presidency, Prescott ends her about a scientist who human egg was success- book on a sober note. She points to the obtains a spot of blood fully fertilized outside fact that EC has not lived up to the most from the cross on which Jesus was the womb in Cambridge, England. In positive scenarios depicted by some of its crucified, and then uses it to clone a 1978, the first ivf baby, Louise Brown, earliest promoters because the avail - man. The lines between fiction and was born. The derivation of human ability of the drug has not appreciably reality have already begun to blur. embryonic stem cells in 1998 led to the affected the unintended pregnancy rate Just what may soon be possible is made first verified cloning of a human embryo in the United States. (Nor, one should clearer by Thomas Banchoff’s Embryo in 2008. Also in 2008 the British govern- point out, has the drug’s availability led Politics: Ethics and Policy in Atlantic ment disclosed that it had permitted to the outbreak of “promiscuity” Democracies. scientists to solve the problem of the warned of by its detractors.) Most com- shortage of human eggs for research by pellingly, Prescott acknowledges the GAIL GROSSMAN FREYNE, LLB, PHD, is the creation of animal-human hybrid economic inequalities in the US that currently a family therapist and mediator in embryos as a source of stem cells. This decades of feminist health activism private practice in Dublin, Ireland (www. high-tech innovation paradoxically feels have been unable to address, and which gailfreyne.org). She has previously worked as like being plunged back in time to a lawyer in Melbourne and Queensland in “pose an insurmountable barrier to Australia and in New Orleans, La. She is the ancient Greece and Rome and myths those unable to afford the products of author of Care, Justice & Gender: A New about centaurs, satyrs and other half- this self-care revolution.” I Harmony for Family Values (Veritas, Dublin). human creatures.

vol. xxxiii—no. 1 2012 43 It is my belief, as I laid out in Care, gressed unhindered by intervention another theologian from Germany, rea- Justice and Gender, that philosophical from the Catholic hierarchy. The author soned that if twins are not formed until reflection is always ultimately pared reminds us that in 1968 the bishops of two weeks after conception then “indi- down to two questions: What is human England and Wales issued a statement vidualization seems not yet to have identity and what is the best way for supportive of ivf research, as did the reached that point which is indispens- human beings to live together? As Ban- future pope, John Paul I, then Cardinal able to personhood.” Therefore, if the choff’s tale unfolds, the crux of human Albino Luciani, who sent public con- embryo up to two weeks is not a person, identity is contained in the question: is gratulations to the Brown family. But ivf then maybe research, carefully con- a human embryo a fully human being? programs require many more fertilized trolled, should be permitted. Does it become human at the moment eggs than are implanted. What is to be of conception or implantation? Is con- done with those that are left over? nce ivf was established as ception an event or a process? In an As far as the Catholic hierarchy led a fertility treatment, the contours attempt to answer these and related by Pope John Paul II and Cardinal O of the debate began to widen. questions, the author makes many sug- Joseph Ratzinger was concerned, ivf as Respect for the embryo was universal, gestions about the best way for the a fertility treatment was to be com - but was not biomedical research, under- embryo, the elderly and everyone in pletely rejected. The embryo—and they pinning an ethic of healing, also a moral between to live together. Nation-states did not pronounce upon whether it had imperative? As time passed, the debate must deal in politics and policy for the a soul or not—was to be treated as a became more polarized. The Catholic good of all, yet, as the book makes clear, human being with all the attendant hierarchy and the Evangelical commu- many individual citizens have very dif- rights from the moment of conception. nity in North America fused the issues ferent views of what constitutes the Theologians differed in their opinions of embryo research and abortion. Scien- common good. on ivf. One German Jesuit theologian, tists, on the other hand, increasingly What began with the race to produce Karl Rahner, wondered whether rights emphasized the healing powers of the first test-tube baby continued with could attach to the 50 percent of the eggs research. During this period it became research that—in the beginning—pro- that failed to implant. Bernard Häring, clear that an ethic of rights was com - peting with an ethic of care. It was a classic case of defining the problem as an either/or situation when what was Reports Worth Reading required was a both/and solution. Banchoff describes this polarization Induced Abortion: Incidence and Trends Worldwide from 1995 to 2008 as being most intense in the United G Sedgh et al., The Lancet, January 19, 2012 Kingdom and the United States, at least Using data from the Guttmacher Institute and the World Health Organization, this in public debate. In America a ban on report demonstrates that the global abortion rate has leveled off. Between 1995 federal funds for embryo research was and 2003, it decreased from 35 to 29 per 1,000 women of childbearing age, but upheld even while private research was seems to have reached a plateau in 2005, when the rate was 28. Chief researcher allowed to proceed unimpeded and Gilda Sedgh said, “This plateau coincides with a slowdown in contraceptive unregulated. Britain was the most per- uptake. Without greater investment in quality family planning services, we can missive, allowing embryo research— expect this trend to persist.” A breakdown by region showed that liberal abortion even the creation of embryos for this laws tend to be associated with lower abortion rates. Also examined are health and purpose—under carefully monitored mortality measures associated with unsafe abortion and trends specific to the conditions. In Germany, and to a lesser developing world. degree in France, the legacy of Nazi eugenics was the determining context Who Decides? The Status of Women’s Reproductive Rights for controversy. The idea that experi- in the United States mentation might interfere with the dig- NARAL Pro-Choice America Foundation, 2012 nity of the human person informed The year 2011 was an eventful one on the reproductive heath front. The 21st edition both secular and religious thinking. As of Who Decides? helps make sense of the changing picture of choice in the US. State a result, eugenic anxieties led to a total laws and legislative activities related to choice issues are listed according to topic ban on research. France, with its separa- (insurance, counseling rules, emergency contraception, low-income women’s tion of church and state established by access to family planning, etc.) and also depicted by state in map form. The overall legislation passed in 1905, is a secular tenor of state and federal legislative bodies is mapped out according to where political culture. Even French Catholics policymakers come down on the choice issue. couched their arguments about embryo

44 conscience book reviews research in non-theological language. Japanese team reprogrammed adult a sense that the ever-present tension— The result was the same as in Germany: body cells to act like embryonic ones. in all four countries stretching through experimentation on embryos was These induced pluripotent stem cells all four decades—between protecting banned. Interestingly, it was Immanuel (ips) held out the possibility of regen- life and alleviating suffering is in danger Jakobovits, chief rabbi from England erative medicine without the destruc- of becoming an unbridgeable chasm. As and an expert in Jewish medical ethics, tion of embryos as, of course, did the the rift widens there seems to be little who provided a possible philosophical use of adult stem cells. Then followed policy discussion or political drive for bridge. He supported research with sur- the procedure known as Preimplanta- regulation. The doers are far outpacing plus ivf embryos for worthy goals but tion Genetic Diagnosis (pgd), a proce- the thinkers. Most disturbingly of all, insisted that “no embryo should ever be dure that screens human embryos as the quality of public ethical debate generated for the purpose of experi - before transfer to the womb. Cystic declines there is no guarantee that eth- mentation.” Ultimately, both France fibrosis and Down syndrome may be ical reflection will be central to the and Germany criminalized all destruc- identified early while the sex of the future of embryo politics. If you refuse tive embryo research. child can now be determined with cer- to discuss the question, how can you be So far, Banchoff’s narrative has been tainty. The author quotes a 2006 study part of the answer? concerned with my first question: what in the United States that found that For this reason, I have no hesitation in is human identity? Each nation was three-quarters of US-based fertility recommending this book. It is a store of from the beginning concerned with the clinics surveyed offered pgd services information presented in a comprehen- rights of the embryo, its protection and and two-fifths offered a sex-selection sive, lucid and accessible format for the the contours of human dignity. Now, option. A healthy child of the gender of lay person. While Banchoff raises ques-

In 1968 the bishops of England and Wales issued a statement supportive of ivf research, as did the future pope, John Paul I, then Cardinal Albino Luciani. breakthroughs at the turn of the cen- one’s choice became closer to being a tions for the reader’s consideration, the tury in stem cell research and cloning certainty. The next logical step might book does not contain comprehensive suddenly offer the prospect of regen- be genetic enhancement, meaning that answers. Not because the author has erative medicine—or, as Banchoff Huxley’s Brave New World is getting failed in his task, but because such answers describes it, “a future horizon of regen- closer to science than fiction. What the do not exist. As in most, if not all, moral erative medicine burst onto the public German government once idealized—a reflection, we need to be satisfied with the imagination.” Immediately, new ethical society of healthy boys with fair hair best answers we can produce for the considerations move the discussion to and blue eyes—could now be created by present, always acknowledging that as my second question: what is the best science in the service of eugenics. new technologies and circumstances way for human beings to live together? Certainly the old questions con - come to light we might have to alter these What constitutes human flourishing? cerning the moral status of the embryo answers. The proclamation of an absolute Embryo science’s new concern with persist with respect to these new tech- truth, even the search for it, is never wise. healing gave new traction to the ethic nologies, but they also raise new and Human beings, however we define them, of care. larger questions about human freedom are finite creatures and so are the answers Not surprisingly, the official stance of and equality, even the future of human we produce. If ethical reflection teaches the Catholic hierarchy did not change. evolution. Children selected or engi- us anything it is that the questions are In the summer of 2000 the Vatican stated neered for certain traits could be said to always more important than the answers again that the destruction of embryos lack a degree of autonomy. Uneven —no matter on which side of the Atlantic was “a gravely immoral act and conse- access to technologies would simply we find ourselves. quently gravely illicit.” As Banchoff reinforce social inequalities and the The last word on these emerging notes, it addressed an ethic of healing health of the poor would suffer dispro- debates belongs to Simone Veil, the head-on with the familiar argument that portionately. As Banchoff points out, French lawyer and government min- the end does not justify the means. genetic enhancement could lead to a ister who suggested to her colleagues in At the same time, there were others genetic caste system or even a race of the National Assembly, “The progress who thought that new technologies superheroes. of knowledge is a challenge for the might require new thinking. In 2006 a As the book draws to a close there is collective conscience.” I

vol. xxxiii—no. 1 2012 45 to transnational religious communities The Ties that Bind: advocating for change in US foreign policy, in the sense that the Maryknoll Religious Communities order has a traditional focus on missionary work. After witnessing the poverty, eco- and Political Change nomic and social disparities and political repression in Nicaragua, many Maryknoll By Sarah Raleigh-Halsing members returned to recount their experiences at Masses across the country and to ask for money for the people of Nica- Reverse Mission: Transnational Religious Communities ragua. They also educated the American and the Making of US Foreign Policy public about the violence inflicted on Timothy A. Byrnes Nicaraguans at the hands of the counter- (Georgetown University Press, 2011, 196 pp) revolutionary forces known as Contras, 978-1-58901-768-9, $26.95 who were supported by the US military and the Reagan administration. Many of the sisters expanded their missionary edu- nited states foreign sionary work. Defining the term for the cation work beyond the confines of Cath- policy has been profoundly broader context, Byrnes states that a olic parishes and schools and spoke at shaped by the desire to “reverse mission” is the process by which public rallies, non-Catholic religious insti- contain perceived threats of a religious community or some of its tutions and ngos in the United States. communism in Latin Amer - members advocate on behalf of their reli- In the third case study, Byrnes exam- Uica, preventing them from reaching the gious brothers and sisters abroad who are ines the Benedictine brothers at the US’s backyard. Following affected by US foreign Western Priory in Vermont. A tradition- this strategy in the 1970s policy but have no leverage ally monastic order, in the 1970s the and 1980s led to a history in the United States to brothers established a close bond with a shared by many countries address their grievances. group of Benedictine nuns living in in the region—one of The book moves beyond a Mexico known as Las Misioneras Gua- political repression, civil general history of libera- dalupanas de Cristo Rey. This connec- war, poverty and the in - tion theology and the tion served as an educational opportunity stallation of brutal military Catholic church’s social not only for the brothers, who learned dictatorships supported justice work in Central about the political, economic and spiri- and aided by the US. America and Mexico and tual realities of their sisters in Mexico and Drawing on his previous provides an in-depth and the community they serve, but also as an work and interest in reli- compelling examination outreach opportunity for US citizens as gion and politics, Timothy of how religious commu- a whole. Byrnes gives a unique nities have created change. The Western Priory community helps perspective on the influ- In the case of the organize retreats for US laypersons who ence religion plays in shaping US foreign Jesuits, one of the order’s guiding prin- wish to spend time living at the Guada- policy decisions in Latin America in his ciples, education, tied the men of the lupe Center, an outreach center run by book Reverse Mission: Transnational Reli- US Jesuit community to their counter- the Benedictine sisters that offers support gious Communities and the Making of US parts in El Salvador. The 1989 murder and services to the poor of Cuernavaca, Foreign Policy. of six Jesuit priests from the Univers- Mexico. The experience of “la realidad The title of the book is taken from the idad Centroamericana in San Salvador [the reality] of Mexican poverty” helps Maryknoll belief that, in addition to at the hands of the Salvadoran military make connections between the economic spreading the word of God and sharing in was the catalyst for action by Jesuit and political dynamics in the US and the plight of the communities where they leaders in the US. Following the mur- Mexico that retreat participants can take are posted on religious missions, the con- ders, they spoke out against United back to the community. sciences of US citizens and actions of the States foreign policy, advocated for Byrnes argues that the level of inf luence US government are also fair game for mis- change in El Salvador and demanded attained by the religious communities in legal action against the murderers. these case studies was dependent on the SARAH RALEIGH-HALSING is the development The Maryknoll sisters’ connection to institutional structure and mission of the associate at Catholics for Choice. Nicaragua represents a different approach three communities he researched. For

46 conscience book reviews example, the Jesuits maintain the same Drawing specific causal links between spread across the country, enlisting military structure and outward disci- advocacy, influence and policy change is, churches and monasteries as safe havens plinary ethos established by the order’s as Byrnes states, “like trying to identify a for individuals and families fleeing their founder, Ignatius of Loyola, which helped black cat in a garbage can at night.” That home countries to escape political them as the US community’s leaders lob- being said, the influence of these religious regimes. Without directly working bied for change by using their political communities was felt in tangible policy against the US foreign policy—and US- connections. Respected Jesuit universities changes. The Jesuits’ role in influencing funded militaries—that brought families like Georgetown University and Boston Congress to reduce US financial support across the border, the Sanctuary Move- College were also well-placed to gain to the Salvadoran government and con- ment sought to soften the humanitarian media attention and political support to sequently the Salvadoran military was impacts of those policies. change US relations with the Salvadoran significant. US Representative Nancy The author briefly analyzes ideological government while advocating for legal Pelosi stated on the floor of the House of shifts within the Catholic church during action against their colleagues’ murderers. Representatives, “Many of us in this body the 1960s, including the assassination of There are parallels between the ratio- belong to the Jesuit family; either we have Archbishop Oscar Romero, liberation nales for action of the Maryknoll sisters brothers, sisters or children who have theology and the Second Vatican Coun- and the Jesuits, two communities whose been educated by the Jesuits, and know cil’s vision of a church that is open to the members confronted the murder of their the close ties that bind…. We have been world. These all profoundly influenced colleagues at the hands of a US-supported hearing from those of the Jesuit family for the Jesuit, Maryknoll and Benedictine military or government. The transna- a ceasefire, for a negotiated settlement, orders, raising the political consciousness tional community the Maryknollers for an investigation into the slayings and of these communities and helping them established differed from that of the a second look again at our policy in El organize for maximum effectiveness as Jesuits in that the group they connected Salvador.” Other prominent members of advocates for change. with was not other sisters or Americans Congress like Senators Patrick Leahy and In his analysis of the Maryknoll and doing aid work, but the Nicaraguan Chris Dodd also had direct and personal Benedictine orders, Byrnes touches on people themselves. Thus, the channels ties to the Jesuit community which they the important role gender plays in through which Maryknoll sisters advo- shared during congressional debates. defining roles in each group, as well as cated for policy change were less tied to The Jesuit connection and the already how gender can define the type of traditional means of lobbying on Capitol percolating discontent in Congress reverse mission and policy impact cre- Hill in Washington, DC, or working to toward US foreign policy in El Salvador ated. The contrast between feminine influence the political elite. Byrnes does resulted in military aid being cut in half and masculine roles in religious orders cite Speaker of the House Tip O’Neill, in 1990. The financial support for the Sal- deserves a more thorough investigation, whose support for the Maryknoll cam- vadoran military was subsequently rein- but for a book whose thesis is defining paign to change US policy in Nicaragua stated the following year as a bargaining how a particular transnational religious was linked to his close friendship with tool to keep the military involved in peace community affects US foreign policy, Sister Peggy Healy. The author concludes accords, which were signed in 1992. the author moves skillfully beyond the that the Maryknoll community’s greatest While public influence and political paradigms often used in comparative impact on policy was due to the “sisters’ power certainly play a central role in cre- politics and political science that tend to efforts to evangelize US citizens by ating policy change, Byrnes makes the omit both gender and community. informing them of what was being done important point that individuals and local I found myself reading Mr. Byrnes’ in their name.” groups, even those lacking the political book with a deep interest in his com - The Benedictine brothers of Ver - influence of religious groups like the parison of the methodologies used by the mont’s Western Priory have probably the Jesuits, still play a significant role in chal- three religious communities to imple- least traditional means of advocacy for US lenging US foreign policy. The Sanctuary ment policy changes. One of the most policy change, which they use to improve Movement, for example, was started in powerful arguments I found in the book the lives of Mexicans who are served by the early 1980s in Arizona by two men was that change at the international the nuns of the Benedictine order in who assisted refugees in border crossings level—and, I would argue, at the national Cuernavaca, Mexico. Like the Maryknol- and asked local churches to house them. level—is less driven by the concept of lers, the brothers had an indirect approach The churches offered sanctuary for those ethnic or national origins tying people to a reverse mission. They created groups fleeing violence and poverty in Central together to advocate for change. Rather, of laypeople who cared deeply about the America and Mexico, with the idea that the ties that bind are from a fundamental fates of the people of Mexico and spoke immigration officials were less likely to drive to identify and connect with those out against US foreign policy that had force their way into a house of worship to who share the same communal loyalties adverse effects on Latin Americans. apprehend refugees. The movement that we hold ourselves. I

vol. xxxiii—no. 1 2012 47 postscript

“We have only to look at Nazism and Communism and the manner in which they violated religious freedom to see how similar it is in today’s world with the desire to “[It] is about the size of an 18-hole golf redefine human life and its origins; to justify abortion; course, so it’s not that big.” 1 to redefine marriage to justify same-sex unions; and to redefine medical care to justify abortion, contraception, —Cardinal Timothy M. Dolan, describing Vatican City to and euthanasia and then to impose these new 5 journalists before his elevation to cardinal. definitions on people of faith.” —Bishop Samuel J. Aquila of Fargo, North Dakota, comparing present-day health and social policies to those of the Nazis.

“Organizers (of the pride parade) invited an obvious comparison to other groups who have historically attempted to stifle the religious freedom of the Catholic “As Catholic pastors, we wanted to remind the Governor Church. One such organization is the Ku Klux Klan…. 6 that conscience, while always free, is properly formed in It is not a precedent anyone should want to emulate.” harmony with the tradition of the Church, as defined by —Cardinal Francis George of Chicago, criticizing organizers of Scripture and authentic teaching authority. A personal an lgbt pride parade. conscience that is not consistent with authentic Catholic “Women lie when they say they were raped.” 7 teaching is not a Catholic conscience. The Catholic faith cannot be used to justify positions contrary to the —Bishop Luiz Gonzaga Bergonzini of Guarulhos, Brazil, alleging that women claim they have been raped in order to access 2 faith itself.” abortion services, which are legal in the case of rape. —Cardinal Francis George of Chicago, in a letter to the Chicago Sun-Times, criticizing how Governor Pat Quinn characterized “Pride of place goes to the family, based on the his meeting with the bishops. Quinn said it focused on the poor; marriage of a man and woman. This is not a simple the bishop claimed it focused on abortion. social convention, but rather the fundamental cell of “Not everyone wants to talk about it, but that is a clear every society. Consequently, policies which undermine factor in the decline of the Catholic community.” 3 the family threaten human dignity and the future of humanity itself.” 8 —Bishop Alexander Sample of Marquette, Mi., on the role of contraception in the declining Catholic school population. —Pope Benedict xvi called for “policies which promote the family” and the restriction of marriage to one man and one woman in his “I can see [American Catholics being arrested for their “State of the World” message to Vatican diplomats. faith], yes.” 4 “It is very hard to give the church a fair shake when the —Cardinal Raymond Burke, head of the Apostolic Signatura, the church itself confuses the hell out of people.” 9 Vatican’s supreme court, speaking about the “war” between secularism and Christian culture in the US, which “will destroy —Journalist Charles Lewis on the Vatican’s “communication us” if secularized culture prevails. problem,” explaining why “criticizing the Vatican shouldn’t always be a sign of anti-Catholicism.”

1 Sharon Otterman, “His Message in Rome: New York Isn’t Sin City,” New York Times City Room Blog, February 14, 2012. 2 Neil Steinberg, “Is It Still OK to Elect Catholics?” Chicago Sun-Times, December 18, 2011. 3 Jim Graves, “Bishop Alexander Sample on the Need for a Renewal of Orthodoxy,” Catholic World Report, November 1, 2011. 4 David Kerr, “Cardinal Burke Reflects on his First Year in the Sacred College,” Catholic News Agency, November 28, 2011. 5 Bishop Samuel J. Aquila, “We must bring Christian values to public square to build just society,” New Earth (Fargo, ND)¸ December 2011. 6 Brian Slodysko, “Cardinal defends Klan comparison,” Chicago Tribune, December 29, 2011. 7 PragmatismoPolitico.com.br, “Absurd: Bishop suggests that women are only raped when they want to be,” June 20, 2011. 8 Philip Pullella, “Gay marriage a threat to humanity’s future: Pope,” Reuters, January 9, 2012. 9 Charles Lewis, “Criticizing the Vatican Shouldn’t Always Be a Sign of Anti-Catholicism,” National Post, November 2, 2011.

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Index: Abortion Law and Women’s Health Worldwide

Changes in abortion laws between 1997 and 20081 Countries that expanded the grounds for legal abortions ...... 17 Benin, Bhutan, Cambodia, Chad, Colombia, Ethiopia, Guinea, Iran, Mali, Nepal, Niger, Portugal, Saint Lucia, Swaziland, Switzerland, Thailand and Togo Regions that liberalized abortion laws ...... 2 Mexico City, parts of Australia Countries that further limited restrictive laws ...... 3 El Salvador, Nicaragua, Poland

Correlation between abortion law and abortion rates2 Abortion rate per 1,000 women Abortion rate per 1,000 women Restrictive laws of childbearing age in 2008 Liberal laws of childbearing age in 2008 Africa ...... 29 Eastern Europe ...... 43 Asia...... 28 Western Europe ...... 12 Latin America ...... 32 North America...... 19

Abortion-related deaths per 100,000 procedures3 United States...... 0.6 Worldwide ...... 220 Sub-Saharan Africa ...... 460

Yearly health impact of unsafe abortions in the Global South (2005 data)4 Women who need medical attention for complications ...... 8.5 million Women who need medical attention but do not receive it...... 3 million

1 Guttmacher Institute, “Facts on Induced Abortion Worldwide,” January 2012. 2 Sedgh G et al., “Induced abortion worldwide in 2008: levels and trends,” Lancet, 2012. 3 World Health Organization (WHO), Unsafe Abortion: Global and Regional Estimates of the Incidence of Unsafe Abortion and Associated Mortality in 2008, sixth ed., Geneva: WHO, 2011. 4 Singh S, “Hospital admissions resulting from unsafe abortion: estimates from 13 developing countries,” Lancet, 2006, 368(9550):1887–1892.