Recent Resources for Feminists
"An artist is not a special kind of a person -- every person is a special kind of an artist" -- Ananda Coomaraswami
IN LOVING MEMORY OF LISA BELLEAR
Noonuccal people of Minjerribah (Stradbroke Island), Queensland
When someone who shines this brightly leaves us, it can be so painful to go on.
Must we outlive everyone we love and who inspires us? But we must go on.
We must go on because people like Lisa would say, "Come on tidda (sister), the sky is still blue outside and the sun is still shining."
And we must go on because while we live here, we can at least hold their everlasting spirit within.
People like Lisa Bellear will always inspire us, no matter where they are, in the flesh or in spirit.
Lisa lives on inside ALL who love her.
We will go on because we are each the source of our own love.
As difficult as it may be, we will go on and we will make even more effort than we did before, to nurture, respect and support our indigneous Australian brothers and sisters.
Lisa would have wanted it that way.
We'll love you always, Tidda.
Safe journeys. XXX - From all of us at The Thylazine Foundation
Sydney Morning Herald -- Monday July 24 2006
An inspiring, dynamic warrior woman
Lisa Bellear, 1961-2006Lisa Bellear was an integral and admired part of the new face of radicalised Aboriginal arts, a poet, photographer, activist, spokeswoman, dramatist, comedian and broadcaster.
One night earlier this month she said goodnight and went to bed at her home in Brunswick, Melbourne. The next morning the clean-living, apparently healthy Minjungbul woman was dead.
She was found in peaceful repose by morning light, leaving relatives and friends to comfort each other in their shock. Bellear was just 45, and the coroner reported that she had an unusually enlarged heart.
Lisa Marie Bellear documented a quarter-century of mostly Aboriginal community life, especially in the fields of politics and the arts.
Her passion for social change saw her contribute to myriad campaigns and groups - protests at the 1982 Brisbane Commonwealth Games; academics and students she taught and studied with at universities, including Melbourne and La Trobe; Sorry Day; the National Aborigines and Islanders Day Observance Committee; poets; feminists; lesbians; the National Day of Healing; the stolen generations; Brunswick Power football team; and the Labor Party.
She broadcast on 3CR in Victoria, where she helped found Not Another Koori Show more than 20 years ago. And she was a "relentless" photographer whose shots represented Australia at the 2004 Athens Olympics.
Nearly 1000 mourners attended her funeral at the Victorian Aborigines Advancement League in Thornbury, spilling out of the building.
"If you're a blackfella in this town, you go to a lot of funerals," her friend and fellow activist Gary Foley said, "but I've never seen that before, where people wait for the coffin and clap it when it goes by. It's the sign of an amazing person. She was dynamic … inspirational."
A painter, Richard Bell, who was a pallbearer, recalled how Bellear would get her photographic subjects to relax: "She had this strategy. She got them to take a photograph of her. There was an exchange there, between her subject and herself. People gave themselves freely."
Australia's record of stiff, long-suffering, staged shots of Aborigines was in contrast to Bellear's casual snaps of moments of solidarity, levity and self-discovery.
The former Victorian premier Joan Kirner recalled how Bellear always called her "Premier", even when others called her "the guilty party".
Mick Edwards, captain of the Fitzroy Stars football team, told how Bellear and a fellow poet and playwright, John Harding, had sponsored him when he came out of an institution: "Lisa calmed me. She was like a general - determined and disciplined."
A state funeral was held in Sydney last year for Lisa's uncle, Bob Bellear, Australia's first Aboriginal judge who, with his brother Sol, helped found the Aboriginal Housing Corporation in Redfern in 1972.
Their sister, Joycelyn "Binks" Bellear, from Mullumbimby, had died in Lismore Hospital in 1961, when her baby Lisa was just weeks old. The father walked away and the girl was adopted by a family in country Victoria, a situation that eventually became traumatic, although she remained close to her adoptive brother, John Stewart.
Bellear escaped by boarding at Ballarat's Sacred Heart College before starting a bachelor of social work at Melbourne University, where she topped her graduation class.
She and John Harding were the only two black faces on campus. Harding "melted" under Bellear's beaming smile, and introduced her to the Harding mob, including his influential mother, Eleanor, and sisters, the arts administrator Janina and the artist Destiny Deacon.
"She was always on the go," Harding said. "Frenetic energy: 'Ah-ah-ah - I've gotta go!' You'd watch her and you'd want to take Valium."
She did not want to find her family at first but Destiny Deacon encouraged her. When they finally met, her grandmother, Sadie, fainted on the railway platform. But, for Bellear, the healing could begin.
Bellear wrote Dreaming In Urban Areas (UQP, 1996), a book of poetry. She was a founding member of the Ilbijerri Aboriginal & Torres Strait Islander Theatre Co-op, the longest-running Aboriginal theatre troupe in Australia, whose recent production of street theatre, The Dirty Mile, was based on a Bellear idea and developed by Foley, Harding and the director, Kylie Belling.
The self-professed "warrior woman" has, in the words of the funeral service, "gone back to the Dreaming". Her life had lit a fire, not the kind that burns things down, but that lights the way.
Her body was buried at Mullumbimby cemetery, close to her mother, as she requested, and to her maternal great-grandfather, Jack Corowa, a Vanuatu man blackbirded to cut cane.
Jen Jewel Brown
Volume 355:4-5 July 6, 2006 Number 1
Plan B, Reproductive Rights, and Physician Activism
Rebekah E. Gee, M.D., M.P.H.
Last year, I gave one of my patients a prescription for emergency contraception. When she presented it at a Wal-Mart pharmacy, she was turned away empty-handed. This mother of three, struggling to pay her bills, routinely shopped for groceries and diapers at Wal-Mart. She felt humiliated and judged by the pharmacist, and her access to needed medication was delayed. Through her experience, I became aware of Wal-Mart's refusal to stock Plan B (levonorgestrel).
The refusal by individual pharmacists to fill prescriptions is a contentious issue, and state laws governing such acts vary. But Wal-Mart was running the only national pharmacy chain that categorically refused to stock emergency contraception in its stores. Soon after my patient's run-in, Julie Battel (a nurse-midwife), Katrina McCarty (a policy analyst who works to combat sexual assault and domestic violence), and I each obtained a prescription for Plan B and presented it at a Wal-Mart pharmacy. As expected, the pharmacists refused to fill our prescriptions. So, on February 7, 2006, with the aid of a Boston law firm and two reproductive-rights organizations, we filed a lawsuit against Wal-Mart under a Massachusetts regulation requiring pharmacies to stock all "commonly prescribed medications" necessary to "meet the needs of the community." 1
By the next day, the story had been reported by media outlets worldwide, and several women's advocacy organizations and lawmakers announced their support. The image of women being denied a medication prescribed by their doctors received broad exposure. Within two days, Wal-Mart announced that it was "rethinking" its policy.
On February 14, the Massachusetts Board of Registration in Pharmacy voted unanimously that its regulation required Wal-Mart to stock Plan B. In early March, after we threatened to pursue legal action in state after state until the national policy was changed, Wal-Mart declared that it would stock the product in all stores (as it now reportedly does).
Many low-income women have few affordable alternatives to shopping at Wal-Mart for their daily needs. In rural areas, Wal-Mart may also provide the only accessible pharmacy. The store's refusal to provide patients with needed medication obstructs timely medical care and puts them at risk for unintended pregnancy. In the United States, half of all pregnancies are unintended, and half of these end in abortion. 2 A recent study by the Guttmacher Institute found that unintended pregnancy disproportionately affects low-income and minority women, who face the greatest barriers to care (see graph). Among women living below the poverty line, the rate of unintended pregnancy increased by 25 percent from 1994 to 2001. 3
Unintended Pregnancies in 2001 According to Women's Income and Race or Ethnic Group. Data are from the Guttmacher Institute.
Given concerns about unintended pregnancies, it is striking that Plan B has been so controversial. Wal-Mart's politically motivated refusal to stock it was probably predicated on the debate over the mechanism of action of Plan B, which is often confused with the abortifacient mifepristone. In reality, Plan B is thought to operate in a manner similar to hormonal contraceptives, which can prevent ovulation and possibly render the endometrial environment less habitable for implantation. These methods do not interrupt an intrauterine pregnancy after implantation and thus do not cause an abortion according to any common definition. The American College of Obstetricians and Gynecologists (ACOG) defines pregnancy as beginning at implantation, as does the U.S. government. 4 Some who take issue with Plan B believe that life begins at fertilization and that any interference with implantation therefore constitutes an abortion or is, at least, equally reprehensible.
But Plan B is not all that is under attack. Limiting access to all contraception appears to be the goal of a growing U.S. movement. Anticontraception organizations cite concern about promiscuity, which they argue is promoted by open access to contraception. This movement is bolstered by the refusal of the Bush administration to seek realistic solutions to the U.S. and global epidemics of unintended pregnancy. One of this administration's first actions was to cut funding to international family-planning groups. Our government has been burying its head in the sand, pretending that sex does not happen. This agenda sets women back decades, threatening their right to achieve equally in society by robbing them of options for planning their childbearing. The women of my mother's generation, who fought so hard for these rights, never foresaw this debate.
Faced with common misunderstandings about Plan B, many clinicians are trying to educate the public and to make this medication more widely available through a three-pronged strategy: preemptively providing prescriptions to patients, creating protocols to allow pharmacists to dispense the medication without a prescription, and supporting over-the-counter availability. ACOG recently launched a national "Ask Me" campaign to encourage patients to ask for Plan B and physicians to provide advance prescriptions. Nine states currently provide "behind-the-counter" access, 5 but the Food and Drug Administration rejected the manufacturer's application for over-the-counter status, despite the support of its own advisors.
Impediments to contraception can be legal as well as procedural and financial. In our current cultural climate, the right of women to obtain contraceptives is being called into question. Given the threats that unplanned pregnancies pose to public health in poor prenatal care, increased maternal morbidity, and increased rates of abortion we need to decide whether we are willing to even put this right up for debate.
During the past decade, our patients' need for our advocacy has expanded in unexpected ways. As physicians, we are coaxed into involvement in areas of public life that are tangential to medicine; we find ourselves wrangling with insurance companies, retail corporations, and pharmacists who interfere with our responsibility to patients. These new roles present challenges. Because of the Wal-Mart lawsuit, I received threatening e-mail messages, letters, and telephone calls at home and at work. I was called "Hitler" by a letter writer who accused me of trying to "depopulate" the human race. On national radio, Rush Limbaugh insulted those of us who filed the lawsuit. Derogatory comments still appear on "pro-life" Web pages.
Yet advocacy on behalf of patients is part of our mission as physicians. We are all patient advocates in the examination room, the research laboratory, the media, and Congress. We may not choose such embroilments for ourselves, but more and more, our engagement in them is what our patients require.
Dr. Gee is an obstetrician-gynecologist and a fellow in public policy and health care research at the University of Pennsylvania, Philadelphia.
Massachusetts Board of Pharmacy Regulation 247 C.M.R. 6.02(4)
Finer LB, Henshaw SK. Estimates of U.S. abortion incidence in 2001 and 2002. New York: The Alan Guttmacher Institute, 2005.
Idem. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sexual Reprod Health 2006;38:90-6.
Code of federal regulations: public welfare protection of human subjects. Washington, D.C.: Department of Health and Human Services, 2005. (Accessed June 15, 2006, at http://www.hhs.gov/ohrp/humansubjects/guidance/45cfr46.htm .)
Pharmacy Access Partnership. State profiles. (Accessed June 15, 2006, at http://www.go2ec.org/StateProfiles.htm.)
Volume 355:1-9 July 6, 2006 Number 1
Roe versus Reality -- Abortion and Women's Health
Alexi A. Wright, M.D., and Ingrid T. Katz, M.D., M.H.S.
Sandra Jones was on her way to a Nebraska operating room to have an abscess drained when she learned that, once again, she had defied medical odds. Six months earlier, doctors had diagnosed breast cancer in the 31-year-old mother of two. Because her test results were positive for the breast cancer susceptibility gene 1 (BRCA1) and she was at high risk for ovarian cancer and recurrent breast cancer, they had recommended bilateral mastectomy, chemotherapy, and a hysterectomy, but Jones (whose name has been changed to protect her privacy) was not ready to give up childbearing. Her doctors warned that though it would be extremely difficult for her to conceive after chemotherapy, she should actively avoid pregnancy for at least six months, since it would complicate her disease and the drugs would increase the risk of serious birth defects. After struggling through treatment, Jones returned home to find that her husband had left her. Now, a few weeks later, routine preoperative tests revealed that she was pregnant.
Jones wanted to terminate the pregnancy, but no physician at the hospital was willing to perform an abortion. So several days later, she searched the telephone book and found LeRoy Carhart's Abortion and Contraception Clinic of Nebraska in Bellevue, a small city just south of Omaha.
Carhart is famous among abortion providers. He first made national headlines in 2000, when he helped to overturn a Nebraska law banning "partial-birth" abortion. In a five-to-four decision in Sternberg v. Carhart, the U.S. Supreme Court declared the law unconstitutional because it provided no exception for the woman's health and its vague definition of the banned procedure placed an "undue burden" on women.
Despite this decision, in 2003 President George W. Bush signed the federal Partial-Birth Abortion Ban Act. Carhart and a nonprofit legal organization called the Center for Reproductive Rights filed a lawsuit in Nebraska, as did others in New York and California; in all three states, district and appeals court judges ruled the ban unconstitutional. This past February, however, after Justice Samuel Alito was appointed, the Supreme Court decided to hear Gonzales v. Carhart. Oral arguments will take place this fall.
Carhart is one of the few doctors in Nebraska who performs abortions. Although 35 percent of women in the United States undergo an abortion before they are 45 years of age, providers are increasingly scarce. Each year, 1.3 million women in the United States undergo an abortion, but in 2000 only 3 percent of rural areas in the United States had an abortion provider, and 87 percent of U.S. counties had none. Eighteen states had fewer than 10 doctors willing to perform abortions (see map ).1
Availability in Each State of Providers Who Perform 400 or More Abortions per Year.
Map is based on special tabulations of data from the Guttmacher Institute's 2002 Abortion Provider Survey.
In the United States, nearly 20 percent of hospital beds are in facilities with religious affiliations, most of which prohibit physicians from providing abortions. 2 According to the Guttmacher Institute, although nationwide about 1 in 14 abortions is sought for health reasons, only two hospitals in Nebraska offer pregnancy terminations, and they do so only under rare circumstances, such as intrauterine fetal death; each of these hospitals performs fewer than 10 pregnancy terminations per year. Nevertheless, in 2004, women from many other states traveled to Nebraska for abortions at Carhart's clinic. Occasionally, when a hospital refuses, Carhart is asked to terminate a pregnancy that threatens a woman's health. In a recent case, a woman with severe pregnancy-associated renal failure traveled 200 miles by ambulance for an abortion. She arrived with her hospital identification bracelet and an intravenous line in place, underwent the procedure, and was shipped back to her hospital bed.
Similar events have occurred in many other states. In 1998, the Louisiana State University Medical Center in Shreveport refused to provide an abortion for Michelle Lee, a woman with cardiomyopathy who was on the waiting list for a heart transplant, despite her cardiologist's warning that the pregnancy might kill her. Hospital policy dictated that to qualify for an abortion, a woman's risk of dying had to be greater than 50 percent if her pregnancy was carried to term; a committee of physicians ruled that Lee did not meet this criterion. Since her cardiomyopathy made an outpatient abortion too dangerous, she traveled 100 miles to Texas by ambulance to have her pregnancy terminated.
Some women cross continents to find Carhart's clinic, a small, brown building on the edge of Bellevue. Last year, Carhart and his 10 staff members performed 1250 abortions there. The clinic has three rooms, each equipped with an examination table, an ultrasound machine, and a pulse oximeter. Carhart performs most first-trimester and early second-trimester abortions with a curette and a vacuum cannula, removing the pregnancy sac under ultrasound guidance. He performs abortions up to 24 weeks after conception, the legal limit.
A shy man, Carhart speaks softly and rarely smiles or makes eye contact, except when speaking with his patients. Nearly six feet tall, with thick, white hair, he is a quietly imposing figure. Outside the examination room, almost every sentence he speaks is interrupted by his cell phone on which he is available around the clock since he stopped using an answering service. "I couldn't find enough pro-choice operators," he explained. "We lost a lot of calls from patients because the service wouldn't put them through."
It's hard to imagine him as a robust young surgeon in the Air Force, where he practiced for two decades until you witness his dogged determination to keep abortion available and safe. After leaving the military, Carhart opened a clinic for emergency surgery. Abortions were a small part of his practice until 1991, when, on the day the Nebraska Parental Notification Law was passed, his house and stables burned down, killing 17 horses, his dog, and his cat. Although the fire had started in seven different locations on his property, it was never declared arson, and no one was charged with a crime. "Everything we owned except the clothes on our backs and the cars we were driving was destroyed," said Carhart. "The following morning, I received a letter from someone claiming responsibility, likening the murder of my horses to the murder of children."
The fire transformed Carhart's life. Determined not to "cede a victory to the antis," he began providing abortions full-time. For a few years, he worked in six states, leaving each day at 6 a.m. and returning home at 11 p.m. Now he moonlights in a Kansas abortion clinic to keep his practice afloat, but his primary office is in Bellevue, situated between a gas station and an antiabortion counseling center for pregnant women called A Woman's Touch. The Catholic school across the street erected a granite tombstone after Carhart moved in; engraved with an image of Jesus holding a baby with angel's wings, it reads: "In Memory of the Unborn Child." From the outside, Carhart's clinic looks almost abandoned; its windows were boarded up after people shot through them. Nevertheless, cars are parked outside and protestors cluster together at the edge of the parking lot. A large sign on the building reads: "Abortion and Contraception Clinic of Nebraska."
LeRoy Carhart's Abortion and Contraception Clinic of Nebraska, Bellevue.
Next door, an even larger billboard above A Woman's Touch advertises free pregnancy testing and confidential counseling. Nationally, such centers outnumber abortion clinics six to one. 3 Most are staffed by volunteers and funded by churches, private citizens, or state governments. Thirteen states sell "Choose Life" license plates that help to support these facilities. The Bellevue center was started by Liz Miller, a middle-aged woman with a degree in Biblical studies and training as a licensed practical nurse who used to protest outside Carhart's clinic. A Woman's Touch has an annual budget of $100,000 and serves approximately 60 women per month, free of charge, with the stated aim of providing complete information. "We feel strongly," said Miller, "that women are not receiving all of the information they need to make their decision."
The center is a two-story pink building that looks airy and inviting. Although it is not a clinic, it offers pregnancy tests and employs a nurse to counsel patients. It has a waiting room and several consultation rooms, including one with an examination table and an ultrasound machine. One of the many brochures available in the entryway suggests that abortion is associated with an increased risk of breast cancer and that "a woman diagnosed with breast cancer while pregnant has a significantly longer life expectancy if she gives birth rather than aborting." According to the National Cancer Institute, there is no credible evidence to support these claims; indeed, a recent large meta-analysis found no such link. 4
Signs advertise workshops and retreats for women with "post-abortion stress syndrome." This diagnosis is not recognized by the American Psychiatric Association or the American Psychological Association; a study of women's responses to abortions indicated that distress is greatest before the procedure and that there are few severe negative responses afterward. 5 The center also offers prenatal parenting classes, baby clothes, and postabortion Bible studies. If a woman is "abortion-minded," it offers fetal ultrasonography. "Most of the women who see ultrasounds choose to parent," reported Miller. "Once you watch that little heart beating or see fingers and toes, a sense of regret develops."
Each day, the same protestors assemble outside Carhart's clinic. With signs showing Jesus on one side and mutilated fetuses on the other, they approach each car pulling into the driveway, urging women to visit the center next door instead. "Don't let them destroy the most precious thing inside of you," they shout. The protestors and Carhart's staff have known each other for years and exchange daily barbs; in March, after sending employees threatening letters, protestors began showing up at their homes as well.
The clinic's entryway is flanked by two sets of doors that can lock instantly if the office is threatened. Like most abortion providers, Carhart takes precautions to protect himself and his staff. Each day, he and his wife, Mary, who works with him, drive a different route to work. When they are indoors, they sit away from windows, facing the door. After Barnett Slepian an abortion provider in suburban Buffalo, New York was murdered in 1998, police brought the Carharts bulletproof vests. They wore them until, as Carhart drily noted, "we realized that the antis usually shoot providers in the head."
Inside Carhart's office, the atmosphere changes: the walls are covered with thank-you letters from patients, national awards, and portraits of the horses that were killed in the fire. The members of the staff are full of camaraderie. During abortions, they console women, explaining the procedure and chatting with them about their pets, work, or families. The conversation continues in the recovery room, where women sit in recliners while assistants provide antibiotics, postoperative instructions, and contraceptive counseling. Some patients write in the clinic's diary, which was started by a 14-year-old girl who wrote a letter to future patients, sharing her story and reassuring them about the procedure. Before each woman leaves, she must void her bladder, circle the hallway 15 times, and show that her bleeding is slowing; since many patients live hours away, Carhart's staff makes sure that they are stable before they depart.
When we met Carhart one recent morning, he had already performed two abortions and had eight more scheduled. His next patient was a woman who had come in the previous day and been sent home because the staff did not think she was emotionally ready. She returned with her brother, who spent most of the time outside with the protestors, coming in occasionally to remind her that she was going to hell. In her purse, she carried protestors' pamphlets featuring pictures of developing fetuses. Before starting, Carhart asked her if she was sure she wanted to do this. She nodded. Throughout the procedure, though, she cried quietly. Afterward, Carhart asked whether the protestors had gotten to her. "No," she sobbed. "The guilt did."
That day, Carhart saw high-school students, housewives, a patient with breast cancer, and a Native American woman from a South Dakota reservation 12 hours away. Carhart has many patients from South Dakota, which has only one abortion clinic and mandates a 24-hour waiting period for abortions, parental notification for minors who are seeking pregnancy terminations, and state-scripted counseling. The last South Dakota abortion provider retired 10 years ago, so a doctor from Minnesota flies to South Dakota one day each week to perform only first-trimester abortions at the remaining clinic.
In March, South Dakota Governor Mike Rounds went one step further, signing into law an outright ban on abortion. The measure, intended as a direct challenge to Roe v. Wade, would make it a felony for a doctor to perform an abortion unless it was necessary to save a woman's life. The bill has no exception for rape, incest, or health and does not define what constitutes a life-threatening condition. The ban was scheduled to go into effect on July 1, until a grassroots coalition collected the signatures required to send it to a voter referendum in November. Early signs suggest the ban may be overturned: in a survey of registered voters, 57 percent said they would vote against it, 35 percent said they would vote to uphold it, and 8 percent were undecided.
At the federal level, in Gonzales v. Carhart, the Supreme Court will decide whether to uphold the Partial-Birth Abortion Ban Act that restricts second-trimester abortions to women with life-threatening conditions. A central question is whether the Court will accept the law's definition of "partial-birth" abortion, a term used by antiabortion forces to describe intact dilation and extraction (D&X).
In the act, the definition of "partial-birth" abortion reads:
The person performing the abortion deliberately and intentionally vaginally delivers a living fetus until, in the case of a head-first presentation, the entire fetal head is outside the body of the mother, or, in the case of breech presentation, any part of the fetal trunk past the navel is outside the body of the mother for the purpose of performing an overt act that the person knows will kill the partially delivered living fetus.
Physicians who violate the law could face up to two years of imprisonment, be subject to civil lawsuits, and be held responsible for financial compensation of "all injuries, psychological and physical." Defendants could appeal to their state medical board for a hearing to prove that the abortion was necessary to save the woman's life. However, Carhart notes that "most physicians are not going to risk their careers to prove a woman's condition is life-threatening not if the only backup they have is a state medical board."
Some abortion-rights activists and physicians, including Carhart, argue that the definition of "partial-birth" abortion is so vague that the law would apply to dilation and evacuation (D&E), the procedure routinely used for second-trimester abortions. In Sternberg v. Carhart, Justice Stephen Breyer wrote: "Even if the [Nebraska] statute's basic aim is to ban intact D&X, its language makes clear that it also covers a much broader category of procedures." But antiabortion activists insist that the federal law targets intact D&X exclusively. Clarke Forsythe, the former president of Americans United for Life, said that far from being too broad, the law "is so narrowly drafted that it may never be enforced."
Much media coverage has focused on the rarity of intact D&X; in 2000, for example, this procedure accounted for 0.17 percent of all abortions. Introduced as a method for reducing complications in late second-trimester abortions, it is usually performed over the course of two to three days, beginning with the insertion of a laminaria. Once the cervix is sufficiently dilated, the fetus is removed intact; this often requires collapsing the fetal calvaria so the fetal skull can pass through the patient's cervix. In contrast, D&E is a destructive procedure that involves evacuation of the fetus and placenta, usually in pieces, with forceps and a vacuum. Many abortion providers try to keep the fetus as intact as possible while removing it, though, in order to minimize the retention of products of conception. Some abortion providers argue that intact D&X is safest for the woman, since it minimizes the risk of uterine injury, cervical tears, and retained products of conception. However, the procedure is controversial, even among abortion-rights supporters.
The antiabortion movement argues that the Court's decision regarding Sternberg v. Carhart does not reflect the people's will. More than half of the states have passed "partial-birth" abortion bans, but the Supreme Court's decision made them unenforceable. "Seventy to 80 percent of the public thinks that this is a barbaric procedure," argues Forsythe. "Despite this, the Supreme Court swept away 30 state laws." Forsythe opposes the inclusion of a health exception in the law, arguing that "there is no ban if there's a health exception." In pre-Roe days, many hospitals offered abortion to women with life-threatening or high-risk pregnancies, despite state laws against it. Physician committees decided who was eligible for abortions and often granted them on psychiatric grounds; poor women had limited access to these procedures.
Today, many antiabortion activists believe that late second-trimester abortions should be performed through labor induction so that the fetus will die of prematurity, rather than be killed. But "that is a fine line with a long history," said Kenneth Edelin, who was convicted of fetal manslaughter in 1975 for performing a second-trimester abortion two years after Roe v. Wade. Edelin, now an emeritus professor of obstetrics and gynecology at the Boston University School of Medicine, was a resident in 1973, when a mother brought her pregnant 17-year-old daughter to the hospital requesting an abortion. Edelin attempted to terminate the pregnancy by infusing saline into the amniotic sac but was unable to reach it because of a low-lying anterior placenta. The mother begged him to try another method. She explained that her abusive husband might hurt their daughter if he discovered she was pregnant. After conferring with his attending physician, Edelin performed a hysterotomy, making a small incision in the uterus and removing the fetus and placenta in a procedure similar to a cesarean section.
Four months later, the Boston District Attorney's office discovered the case when it subpoenaed the medical records of 88 women who had undergone abortions. Edelin was indicted. At grand-jury hearings, most of the physicians pled the Fifth Amendment, but Edelin told the truth, believing he was protected by the law. The assistant district attorney who charged him with manslaughter argued that the 20-week-old fetus had become a person once the placenta was detached from the woman and should have been resuscitated. The defense argued that it was stillborn, as indicated at autopsy. Nevertheless, when the case went to trial, Edelin was found guilty.
Newspapers nationwide reported on the trial, and there was an immediate chilling effect. "Once I was indicted, hospitals up and down both coasts stopped performing second-trimester abortions," recalled Edelin. "Many hospital administrators stopped permitting residents to take part in abortion at all." But there was also an outpouring of support from women who had undergone pregnancy terminations before Roe v. Wade. "I received thousands of letters describing women's experiences lying on a kitchen table on a sheet of newspaper with a single light bulb overhead, undergoing an abortion alone without anesthesia, antiseptic, or anyone to support her," said Edelin. "Many women were raped as a part of the process. It's amazing the indignities the risk to life and future fertility these women faced when they were alone and frightened." Edelin appealed to the Supreme Judicial Court of Massachusetts, and eventually the verdict was reversed.
Abortion veterans like Carhart fear that Roe may soon be overturned. If that happens, states will have to choose whether to ban or protect abortion. Most have abortion laws on their books, but they are superseded by Roe, as long as it survives. Antiabortion activists are split on whether they should try to overturn it. After Governor Rounds signed the South Dakota ban into law, his approval rating dropped 12 percent. Most of the public still support some form of abortion: polls show that 66 percent of Americans believe that abortion should be legal in the first trimester and that they overwhelmingly support abortion in cases of rape, endangerment of health, or serious fetal anomalies. Yet in 2006, legislators in 12 states introduced bills that would ban nearly all abortions; as of early June, the governor of Louisiana was poised to sign a ban similar to South Dakota's, which will go into effect if Roe is overturned.
Number of Reported Abortions in the United States, 1973–2002.
Data are from the Guttmacher Institute; data for some years were interpolated.
Watson Bowes, emeritus professor of obstetrics and gynecology at the University of North Carolina, is among those who argue that Roe v. Wade is a misuse of federal authority: "The Supreme Court used raw judicial power to trump state legislators, and the decision should be overturned on those grounds." Other antiabortion activists advocate incremental changes in state laws to limit the provision of abortion. These changes include parental consent laws, fetal homicide laws (making it two crimes to kill a pregnant woman), strict regulations for abortion clinics, and legislation requiring physicians to offer women fetal ultrasonography before an abortion.
This strategy is already having an effect, argued Katherine Grainger, legislative counsel at the Center for Reproductive Rights. "With each year, more and more restrictions on Roe are being passed." Ultimately, Grainger said, "we'll see it slowly eviscerated to the point where . . . it's hollow."
Many older abortion providers believe that the complacency of younger women and physicians is partially responsible for the current state of affairs. "They don't remember the thousands of women who died from septic abortions," argued Edelin. "They don't realize that this is a battle to save women's lives not a battle for choice."
As new legislation is passed, the courts will hear more cases that challenge Roe, and physicians may increasingly risk their careers and their lives if they choose to provide abortions. With each new decision to limit abortion, more American women lose their access. Whether the Supreme Court ultimately upholds or overturns the Partial-Birth Abortion Ban Act, one thing is certain: poor women in rural America are bearing the brunt of these decisions, and some may pay with their lives.
Dr. Wright is a fellow in hematology–oncology at the Dana–Farber Cancer Institute, Boston, and Dr. Katz is a fellow in infectious disease at the Beth Israel Deaconess Medical Center, Boston. Both are editorial fellows at the Journal.
Interviews with Dr. Watson Bowes, emeritus professor of obstetrics and gynecology at the University of North Carolina in Chapel Hill, and Dr. Kenneth Edelin, emeritus professor of obstetrics and gynecology at the Boston University School of Medicine, can be heard at www.nejm.org.
Finer LB, Henshaw SK. Abortion incidence and services in the United States in 2000. Perspect Sex Reprod Health 2003;35:6-15. [ISI] [Medline]
Uttley L, Pawelko R. No strings attached: public funding of religiously sponsored hospitals in the United States. Albany, N.Y.: MergerWatch, 2002.
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Remembering Cynthia Nelson: Friend, Colleague and Mentor President ...
American University in Cairo: A Newsletter for Faculty and Staff March 2006 Vol. XIII, Issue 7
Cynthia Nelson, professor of anthropology, founding director of the Institute for Gender and Women’s Studies (IGWS) and former dean of the School of Humanities and Social Sciences, passed away February 14 at her brother’s home in California after a battle with leukaemia.
Nelson was born on September 29, 1933 in Maine, and grew up between there and Massachusetts in the United States. In 1963, after finishing her doctorate from the University of California, Berkeley, Nelson received a telegram offering her the position of professor in AUC’s sociology-anthropology department. Accepting the offer, she read Lawrence Durrell’s The Alexandria Quartet, watched Lawrence of Arabia and boarded a boat that took her across the Atlantic.
In an oral history interview in July 2005, she told Stephen Urgola, senior librarian and university archivist: “So with that background, off I went. And when people asked me, well why did you go, I said I didn’t know, it was chosen, maktub.”
From the first time she set eyes on the land, Nelson held a positive view of Egypt. “For me it was a kind of coming into being of a kind of romantic image. Because coming into the harbor of Alexandria and the smell of spices, you can almost see some of the characters of Durrell,” she told Urgola.
Nelson fought against an inevitable evacuation during the 1967 War and found a positive side of Egypt during the bread riots. “People were helping each other, … which is what Egypt is about. I mean, even in its most stressful times, there’s a certain decency that emerges,” she said.
Randa Kaldas, her assistant at IGWS who worked closely with her during the last five years, was impressed by both her work ethic and personal qualities. “Whatever needed to be done, she did with passion, not just for the sake of getting things done, but rather always seeking perfection,” she said. “Every trait in Dr. Nelson made her special: her charisma, her knowledge, her warmth, her support to others, even her temper, made her very special.”
The 13 years of work Nelson put into writing the biography Doria Shafik, Egyptian Feminist: A Woman Apart, was, as she told Urgola, her most ambitious project. In recognition of her work, she received the Woman of the Year award in 1998 from the American Biographical Institute. “It turned out to be … that young students at AUC, upon reading it, said we never realized we had such women. … In a sense it’s a kind of interesting process of being able to, I guess be an intellectual midwife,” she told Urgola.
A memorial service commemorating Nelson’s life will be held on March 16 at 5 pm in Oriental Hall.
8 - 14 June 2006 Issue No. 798
Body silent, legacy vibrant
Kevin Dwyer* reflects on the work of Cynthia Nelson, and takes stock of the American University in Cairo's commemorative initiatives
Starting in May and June of this year Cairo and Egypt will be benefitting in two ways from the legacy of Cynthia Nelson, who passed away in February 2006 after more than four decades as a Professor of Anthropology at the American University in Cairo (AUC). On 22 May AUC's Board of Trustees voted to establish a Masters Degree Program in Gender and Women's Studies, bringing to fruition one of Nelson's most deeply cherished goals; and, on 7-8 June, AUC will be hosting an international conference on the theme "Gender and Empire," carrying forward Nelson's interest in the relationship between gender studies and contemporary political and cultural debates.
The new Masters Program in Gender and Women's Studies will be housed in AUC's Institute for Gender and Women's Studies, which Nelson founded in 2000 and directed until her death and which, in her honour, has now been renamed the Cynthia Nelson Institute for Gender and Women's Studies (IGWS). The Masters Program, rooted in the humanities and social sciences, explores how gender relations are embedded in social, political, and cultural formations. It provides students with a unique interdisciplinary and transnational perspective with special emphasis on the Middle East and North African region.
The program prepares graduates for a variety of careers as well as providing a steppingstone for further academic training. It offers excellent grounding for professional activity in the fields of human rights law, health, migration and refugee studies, and social services, in today's context where specialists in gender and women's studies are being hired as consultants in international development agencies, local NGOs, national government agencies and regional universities. The program's interdisciplinary training, it is hoped, will equip students who wish to pursue a doctorate with theoretical and methodological tools suiting a variety of disciplines and applied research. Students enrolling in the program will be able to compete for the newly established Cynthia Nelson Graduate Fellowships in Gender and Women's Studies, funded by contributions from the many individuals who were deeply affected by Nelson's work and life.
The "Gender and Empire" conference being hosted on 7-8 June by AUC and IGWS reflects the fact that gender has become an important theme in debates related to colonial and post-colonial imperial visions. The conference will bring together scholars, writers, filmmakers, and activists from a variety of countries such as Iraq, Jordan, Palestine, Turkey, the US and Egypt, who will explore how gender studies relate to the current age of empire and examine the politics and possibilities of gender studies in the historical present, focussing in particular on the Arab world. With many of the papers highlighting the situation of Iraqi and Palestinian women as well as raising theoretical issues, this conference promises presentations that are likely to contribute to and shape future debate on these subjects.
Both these events are signs of the continuing vitality of Nelson's work. Among her achievements during her more than 40 years in Cairo are authorship of key books and articles on Egypt and the training of a large number of students. In addition to founding IGWS, she was also the founding dean of AUC's School of Humanities and Social Sciences and, in 1996, was awarded the King Hussein Distinguished Service Award for Contributions to Higher Education in the Arab World.
Nelson's many books and dozens of articles made her widely known throughout the Arab world and globally. AbdAllah Donald Cole, an anthropologist and colleague of Nelson's at AUC for more than three decades, noted some of the highlights of her career in an obituary published in the Anthropology Newsletter (May 2006), where he observed that, after her fieldwork in Mexico and move to Egypt and AUC in 1963, "she began research on socialization and change among settled Bedouin, ... [and] the phenomenon of appearances of the Virgin Mary in a Cairo suburb, ... work[ed] on spirit possession ... religious experience, sacred symbols, mental health, stress and social reality in Egypt ... focused on Middle Eastern women and how they had been portrayed in the predominantly male- authored ethnography in the region ... pioneered research on nursing and health care in urban Egypt...."
One sign of her impact on the Arab world comes to us in an article from the Tunisian newspaper Le Temps by Lilia Labidi (professor of psychology and anthropology at the University of Tunis), written shortly after Nelson's passing. Labidi relates how, in the course of an event-filled career, Nelson "organized many international meetings ... [was] a source of inspiration and of new projects ... defended her ideas with great energy and vision ... trained several generations of students who now occupy the highest functions in education, research, and administration. ... her book [on Doria Shafik], now translated into Arabic, is among those works that have marked anthropological production in the region."
A personal note: before coming to AUC in 2001 as professor of anthropology, I had admired Cynthia Nelson's writings from afar; once I became her colleague I gained a growing admiration for her unequalled dynamism, her careful attention to students, her enthusiasm, her high standards, and her commitment to the region. In the few months since her passing, as I met her former students in places as distant from Cairo as Chicago and Vancouver, I became even more aware of her world-wide impact and renown. One evening, when she and I were sharing memories in a restaurant in Zamalek, we discovered we both had great respect for the anthropologist Robert Murphy (known for his research in the Amazon and among the Tuareg in West Africa), with whom we had both worked early in our careers. Cynthia strongly recommended to me his final book, where he explored disability in the United States -- a particularly poignant work since Murphy himself had become disabled, suffering from a tumor that paralysed and eventually killed him at the age of 66. Murphy's book shows the resiliency of the human spirit and I now use it frequently in my courses, hoping simultaneously to remember experiences I shared with Cynthia, to be faithful to her empathy for people and communities that are treated unfairly, and to show students how people in very difficult circumstances can create works that survive them and that project into the future. Murphy's book is entitled The Body Silent, but the title indicates only half the story: although the body lies silent the life's legacy persists. And Cynthia's life, lived so intensely up to its final days, leaves us with an extraordinary legacy -- today exemplified in the new IGWS Masters Program and the Gender and Empire conference -- that belongs not only to the past but to the present and to the future as well.
* The writer is a professor of anthropology at AUC and author of Arab Voices: The Human Rights Debate in the Middle East ( Routledge and University of California Press, 1991 ) and Beyond Casablanca: M.A.Tazi, Moroccan cinema, and Third World filmmaking ( AUC Press, 2004 )
Court ends Colombia's abortion banMike Ceaser
Until recently, Colombian law prohibited all abortions. Nevertheless, about 300 000 to 400 000 women undergo the procedure each year, often performed by untrained backstreet abortionists. A May 10 court decision has now depenalised abortion in three circumstances. Mike Ceaser reports.
Cardiologist Miguel Ronderos walks between the rows of small beds in Bogota's Cardioinfantil Foundation Hospital. Many of these newborn babies have congenital defects that will cause anguish for their parents and cost their families and society fortunes. “In North America and Europe, 90% of major malformations are detected in the womb”, says Ronderos. “Here in Colombia we don't reach 1%.”
Supporters of legal abortion hope this situation will change with a ruling on May 10, 2006, by the Constitutional Court that legalises the procedure in cases of rape, when the pregnancy endangers the woman's life or health, and when the fetus has severe malformations. Until the decision, Colombian law prohibited abortion in all circumstances, so doctors rarely bothered to undertake prenatal tests for even severe congenital defects, since women had no legal option to end their pregnancies.
Despite the prohibition, about 300 000 to 400 000 illegal abortions have been performed annually in Colombia. Until the new decision, Colombia, together with Chile and El Salvador, were the only three Latin American nations that prohibited abortion in all circumstances.
The court ruling came in response to a lawsuit filed last year by Monica Roa, an attorney with Women's Link Worldwide. She argued that Colombia's abortion law unjustly discriminated against women, especially the poor. One study estimates that clandestine abortions cause 28% of maternal deaths in Colombia, a disproportionate number of which are among poor women. “The women who live in rural areas are the ones who pay the cost in health, or even with their lives”, because abortions are illegal, she says.
Before the ruling, all abortions carried prison terms of up to 4·5 years for the woman who terminates her pregnancy and for the abortionist. In practice, in the few cases actually prosecuted, the women were usually sentenced to house arrest.
Advocates for abortion rights celebrated the court's decision, while Catholic organisations vowed to have it reversed. Observers debated the ruling's breadth, particularly whether the term “health” used in the decision included psychological problems and non-life threatening illnesses, and whether fetal malformations included non-fatal disorders such as Down's syndrome. Abortion-rights advocates also expressed concern that women have access to the procedure. In some other Latin nations where there is a legal right to abortion, women are still unable to obtain the procedure because doctors refused to perform it. While the court decision took effect immediately, the legislature and health ministry are expected to write regulations for its implementation.
Ronderos, for one, expects the court decision to be interpreted broadly, and that the public-health system even plans to cover the procedure. The decision “gives the doctor the prerogative to use his own evaluation”, of whether or not an abortion is justified, Ronderos said.
Colombia's prohibition has generated a flourishing underground abortion industry beyond the oversight of health officials. As a result, abortion providers have ranged from doctors operating in well-equipped medical clinics to untrained midwives.
Marcela Caicedo, a social worker with a women's health education programme in a poor area of Bogota, says that a woman nearby does abortions in a dirty house with peeling paint. Caicedo says she doubts the woman has even a high-school diploma, much less medical training.
Many of the more established clandestine abortion clinics are located in a central area of Bogota full of old homes, small restaurants, and store front clinics that offer ultrasound and other health services for women.
On the pavements, men hand out cards advertising treatment for “delayed menstruation”. In one clinic with a sign advertising general medicine services and varicose vein treatment with a “German technique”, a reporter posing as the partner of a Colombian woman was told the “procedure” would cost about US$50. In a second clinic two blocks away, an abortionist described the operation as fast and easy. He assured the woman that her fertility would not be impaired. “There are women who have abortions and get pregnant again right away”, he said.
But a 27-year-old woman who paid about $40 for an abortion in that clinic said she was not given anaesthetics and that when she cried too loudly the employees threatened her with the police and then hurried her out as soon as the procedure was over. Her post-abortion ultrasound was done in another clinic with a hair salon sign on its front. The woman, who requested anonymity, now fears she is infertile.
According to press reports, in early February, a 23-year-old mother of two named Viviana died in the clinic that offered the “German technique” while having an abortion. She had gone to the clinic with her sister, who later told reporters that Viviana had been 4 or 5 months pregnant and feared what the father of her two children would do if he found out. The sisters arrived at the clinic at about 1500 h, and Viviana paid 500 000 pesos ($222), which is a large sum for a lower-middle class family in a nation with a monthly minimum wage of $181. At about 1700 h, the doctor emerged to say that Viviana was bleeding badly. At 0400 h, he acknowledged that Viviana was dead and sent the sister home in a taxi after giving her 20 000 pesos and two beers, and telling her to say that she had been out drinking alone.
But the sister returned with her father and the police. They found the clinic vacant, except for Viviana's body and the doctor, who insisted that he had just dropped by to pay the rent, the sister told local media. “At no time did the [doctor] call an ambulance”, she told local television. The doctor was arrested and released pending an investigation. After Viviana's death, this clinic was closed, with yellow police tape in the windows. But nearby other clinics continued offering their services.
In a second recent case, a 34-year-old mother of four was diagnosed with ovarian cancer while 3 weeks pregnant. Doctors refused to perform an abortion or treat her cancer because that would harm the fetus.
In Bogota's Simon Bolivar Hospital, gynaecologists Daniel Montenegro and Fred Lozano treat about five women a month for complications after abortion. Almost all of their patients are younger than 30 years, the doctors say, many are teens and most are poor. While the doctors recall one case of a young woman who had had 22 abortions, they said that after one, most do not repeat their mistake. Years ago, they often saw “catastrophic” cases, such as a woman in 1982 who arrived with pieces of her intestine protruding from her vagina. Although surgeons found fragments of a fetus near her liver, the woman died still denying she had had an abortion, Montenegro recalls.
In recent years, however, the number of serious complications has declined, the gynaecologists say. They attribute this improvement to the increased availability of contraceptives since the early 1990s, as well as to the use of the morning-after pill. But the greatest decrease, they say, is owing to the popularisation of the use of misoprostol, a prostaglandin analogue used to treat gastric ulcers but which can also induce abortions.
However, in poorer, rural areas, the incidence of complications from abortion continues to be high. In the city of Ibague, with 400 000 inhabitants, health officials recorded three deaths from abortion complications last year. Ibague authorities became so concerned about the high incidence of sexual assault that late last year they began distributing free morning-after pills.
Montenegro and Lozano say Bogota's clandestine abortion industry has become so institutionalised that clinics often phone the hospital before sending over patients suffering complications. The gynaecologists add that most of the illegal clinics' abortionists are actually qualified physicians.
Both doctors support limited depenalisation of abortion, because they believe it will make the procedure safer for women in extreme situations. But even if abortion were completely legal, they say, they would refuse to do the operation except in the three situations included in the ruling. “When a pair of kids have their fun and then want an abortion, no”, says Montenegro. “That's an act of irresponsibility.”
Even providing care after an abortion can bring doctors ethical dilemmas. Attorney Roa says that since she filed her lawsuit, increasing numbers of doctors have reported to police women who seek help for post-abortion complications. Roa says that doing so violates a doctor's legal obligation to preserve a patient's privacy. Yet, although they say they have never done so, Montenegro and Lozano defend informing police when they see that an abortionist has committed malpractice “As a citizen, one has the obligation to denounce illegal acts”, says Lozano.
Ronderos of the Cardioinfantil hospital expects safe, legal abortion will become so accessible that the clandestine industry will shrink dramatically. And he expects to see far fewer newborn babies with severe deformities. “Having a non-viable baby isn't anybody's reason for being a parent”, he said.
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