View Point: Bush Wants To Extend Healthcare To Fetus, Not Pregnant Women

By Priscilla Smith

The gloves are off. After months of leaving women alone, with foreign policy and domestic security issues taking precedence, the Bush Administration's determination to elevate the rights of the fetus over women's health is back.

Earlier this month, the Bush Administration misled the public by claiming that the best way to ensure access to prenatal care is to allow states to extend health care to fertilized eggs rather than to low-income pregnant women directly. Secretary of Health and Human Services Tommy Thompson announced that states could classify a fertilized egg as an "unborn child" eligible for coverage under the Children's Health Insurance Program or CHIP. On the one hand, Secretary Thompson has touted this move as the "fastest way possible" to give more low-income pregnant women access to prenatal care, charging that the plan's opponents care little for women and children. On the other hand, Thompson describes prenatal care as health care for the fetus, leaving the woman out of the equation altogether.

Bush Uses Deception

The women's reproductive rights movement prioritizes the health and well-being of women above all other objectives. Defending women's health means increasing coverage of reproductive healthcare, reducing maternal mortality and morbidity, while at the same time respecting a woman's right to choose when and how many children she wants to conceive.

Not only is the Administration's radical change unnecessary to expand pregnant women's access to prenatal care, but there are two faster ways to achieve the changes. States can request coverage for pregnant women by applying to the federal government for a waiver without the need to designate a fetus as "an unborn child" that has the right to coverage under CHIP. In recent years, Rhode Island and New Jersey made such requests and received waivers to expand their CHIP coverage to pregnant women. Last June, Maryland submitted a request to enroll pregnant women with incomes of 200% to 250% above the federal poverty line in CHIP. That request is still pending approval. If it is serious about improving pregnant women's health, the Administration, which controls the waiver process, should expedite all requests to expand CHIP coverage.

Second, there is already bipartisan support for two bills before Congress that would extend CHIP coverage to pregnant women without the inflammatory language of the Bush policy. With the Administration's support, the bills could become law and the change implemented immediately, rather than waiting for a lengthy regulatory process to be completed taking over three months.

So why the new policy? Another action this past week provides a clue. The Justice Department filed a brief in support of an Ohio abortion ban against the dilation and extraction abortion procedure, even in cases where it would be the safest procedure for the patient. The Justice Department argues that the procedure should be denied to women in circumstances when it was the safest procedure for them, and permitted only in a narrow set of emergency situations. The Justice Department position would require women to undergo more risky procedures even when the fetus is not viable.

Both of the Administration's recent acts are part of an agenda aimed at extending rights to the fetus with an eye to building the legal foundation to overturn the Supreme Court decision in Roe v. Wade. That is an agenda aimed squarely against women's health and rights.

The Bush Administration has implemented an anti-women's rights agenda since taking office. President Bush's first executive order banned international aid to overseas organizations that counsel or advocate for abortion services. Last spring, President Bush supported a federal bill that would have made it a federal crime if an individual caused the death of or bodily injury to a fetus. President Bush told activists attending an anti-choice rally in Washington, D.C. on January 22nd-the 29th anniversary of the Roe decision -- that "unborn children should be welcomed in life and protected in law." In addition, he is currently holding up funds, approved by Congress, to support international family planning programs run by the United Nations Population Fund.

The Bush administration should stop trying to deceive the public by trying to extend rights to fetuses under the guise of better healthcare for pregnant women. What President Bush must do is recognize that the best way to improve women's health is to recognize their right and ability to make private, medical decisions.

Ms. Smith is the Acting Domestic Program Director of the Center for Reproductive Rights. A version of this piece appeared in the Philadelphia Daily News in February.

In The States

The Center Hits The Highways To Defend Reproductive Rights

The Department of Motor Vehicles would hardly seem a likely candidate for a frontline in the women's reproductive rights movement. Nonetheless, anti-choice lawmakers and activists have found a way to turn this once innocuous arm of state government into a fund-raiser for their anti-women's rights agenda. The Center for Reproductive Rights has been fighting back.

Here is how the scheme works. Anti-choice lawmakers push through a bill that allows motorists to purchase a license plate with the phrase "Choose Life" printed on it.

The funds raised through this program are then funneled to anti-abortion organizations, particularly so-called "crisis pregnancy centers" that lure expectant women under the guise of offering medical advice to them only to subject them to anti-abortion intimidation and propaganda. The "Choose Life" scheme forbids funds from being distributed to groups that provide or counsel for abortion services.

Currently, thirteen states are considering legislation that would create these programs. Louisiana, Florida and South Carolina have passed bills for these programs. Alabama will print the plates when 1,000 motorists each pay $50 in advance to order a tag. The Center for Reproductive Rights has filed lawsuits against the Louisiana and Florida schemes.

"This is where it starts," Simon Heller, of counsel at the Center for Reproductive Rights, told the Village Voice last December. "But eventually these things become accepted as the norm in our culture. The risk is that this will spread very widely around the country and you have this government-sponsored propaganda everywhere."

The anti-choice movement is making no attempt to cloak their support for these schemes. Last year, the National Right to Life Committee's web site posted a message by Jeanne Gill following a Florida court's dismissal of the National Organization for Women's challenge to Florida's "Choose Life" scheme. "We can really start spreading the word about the 'Choose Life' license plate," Gill wrote. "We only have 46 more states to go."

Florida's passed its "Choose Life" law in 1999. The fund has collected in excess of $600,000. In August 2001, more than $426,000 was distributed to the Florida counties and at least seven counties began dispersing the funds with some going to Catholic charities.

"Florida's license plate scheme is an unconstitutional violation of free speech because the state will not distribute funds to groups that even mention the option of abortion," says Brigitte Amiri, the Center for Reproductive Rights attorney who represents the plaintiffs in the Florida challenge, Women's Emergency Network v. Bush.

The Center for Reproductive Rights filed a lawsuit to stop the distribution of state funds and eventually recall the license plates. We contend that the program promotes one view of abortion to the exclusion of all others. In February, a state judge denied the Center for Reproductive Rights' motion for a preliminary injunction to prevent Florida from distributing any more of the funds from the "Choose Life" program. The judge's decision was based on the timing of our motion and the fact that only one county, Palm Beach, was subject to the court's control. Palm Beach county agreed not to distribute its funds until the court resolves the case.

The Louisiana case, Henderson v. Stalder, like the Florida case, challenges a law passed in 1999 that mandates that state taxpayer dollars be used to make and distribute the license plates, and proceeds from the sale of the license plates be deposited into a "Choose Life Fund."

In the Louisiana case, the Center for Reproductive Rights obtained a preliminary injunction from the district court, which prevented the state from distributing the license plates. We are currently awaiting a decision by the U.S. Court of Appeals for the Fifth Circuit, on the State's appeal of the preliminary injunction.

Worldwide

View From Abroad: Ireland Faces An Anti-Abortion Referendum

By Julie F. Kay

Ireland's abortion law is among the most draconian in the world, yet the government is attempting to further restrict reproductive rights by holding a referendum that would eliminate the threat of suicide as a justification for a legal life-saving abortion.

This referendum is almost identical to one Irish voters rejected nearly a decade ago. The outcome of the March 6 referendum is impossible to predict at this writing. Ireland's abortion debate is one of constant tension between a rigidly anti-abortion constitution and public empathy for Irish women's experience of traveling abroad for abortion services.

Ireland's law bans abortion except when continuation of pregnancy poses a "real and substantial risk" to a pregnant woman's life. An 1861 criminal law makes a woman and anyone who assists her in obtaining an abortion criminally liable. To bolster this law, in 1983, voters amended the Constitution to give the "unborn" and the pregnant woman an equal right to life. This amendment succeeded in part because anti-abortion groups raised fear that the Irish Supreme Court would legalize abortion by following the United States Supreme Court's reasoning in Roe v. Wade.

The availability of legal abortion in England has prevented widespread development of illegal abortion services in Ireland. However, the hardship experienced by at least 7,000 Irish women each year who travel to England for abortions cannot be dismissed. Furthermore, at a cost of approximately 1,000 euros (more than $1,200), traveling abroad for an abortion is simply not an option for many women. In practice, abortion remains largely unavailable in Ireland even in life-saving instances because the law defining the circumstances in which a doctor may perform a life-saving abortion is so ambiguous. (There has been some documented evidence of doctors performing abortions to save lives in individual cases.)

The abortion debate ignited in 1992 around the Irish Supreme Court case involving a 14-year-old girl, pregnant as a result of rape. To obtain an abortion the girl and her parents traveled to England. The girl's father had contacted the Irish police before leaving, to inquire whether a fetal tissue sample should be preserved as evidence against the rapist. In response, the Attorney General obtained a High Court order prohibiting the girl from seeking an abortion or otherwise traveling outside the country for nine months. The family returned to Ireland with a still-pregnant and now suicidal daughter, and appealed to the Supreme Court.

The Supreme Court ruled that that the girl could receive a legal abortion in Ireland because the risk of suicide was a 'real and substantial risk' to her life. The March 6 referendum now seeks to close this "loophole" by excluding risk of suicide as grounds for a legal and life-saving abortion.

Women On Waves supporters. Photo by Andrew Flood.

The referendum does not reflect the two decades of liberalizing of public opinion on abortion in Ireland. That period has seen large public demonstrations supporting abortion rights, specifically at the time of the case of the 14-year-old girl. More recently, the broad pro-choice movement demonstrated visible support last summer for the Women on Waves project, a ship with a fully equipped reproductive health care clinic that travels to countries where abortion is illegal. In 2001, a nationwide poll conducted by Lansdowne Market Research for the pro-choice group Abortion Reform, showed that almost two-thirds of those surveyed believed that abortion should be permitted in some circumstances.

Yet the political landscape remains fixed. No government has ever put forward a referendum proposal that would give voters the opportunity to vote for greater access to abortion within Ireland. This is a failure of the parliament and the courts to recognize women's reproductive rights as human rights. In the meantime, an extensive, and expensive, pro-choice campaign is being waged to defeat the latest anti-abortion amendment in Ireland.

Ms. Kay is a former Center for Reproductive Rights staff attorney and currently a legal consultant with the Irish Family Planning Association (IFPA) as part of a partnership project with Women's Link Worldwide.

Displaced and Disregarded: Refugees and their Reproductive Rights

Ziba says she is in her thirties, but malnutrition and a life of struggling to survive in war-torn Afghanistan have stolen at least twenty years from her. She is a Pashtun Afghan, mother of five sons and a resident of the New Shamshatoo refugee camp that lies roughly 24 miles north of Peshawar, Pakistan.

Ziba was pregnant with twins not long ago, but when she went into labor she became extremely ill. The closest medical clinic to New Shamshatoo was at least thirty minutes away, forcing her to remain in her tent.

Afghan refugee women and children at the Shamshatoo Refugee Camp. Photograph by Mike Huggins for the World Food Programme.

"I didn't have enough food or medicine to be healthy enough to carry the twins," Ziba told an interviewer from a team of investigators for the Women's Commission for Refugee Women and Children last year. Her name has been changed for the purpose of confidentiality.

"I was very ill because the baby had died in my stomach," she added. "It was night and suddenly there was blood everywhere. My husband went and brought the old dai (traditional birth attendant). I gave birth to the dead baby with great difficulty."

Ziba's other newborn survived only 11 days in an incubator at the hospital. Her experience is frighteningly common for women in refugee camps around the world. Women and children comprise 80% of the world's 22 million refugees. The UN Population Fund (UNFPA) estimates that one in five pregnant refugee women "face a heightened risk of malnourishment and infectious diseases, and are subject to hazardous conditions when giving birth."

"Refugee women and girls are among the world’s most disenfranchised people," said Kathy Hall Martinez, deputy director of the Center for Reproductive Rights' international program. "The horrors that refugee women and girls face include not only fears about their physical security and future but also their ability to access basic housing, nutrition and health services."

When refugee women and girls decide they do not want to carry a pregnancy to term, they are often forced to turn to unsafe abortions because of poor access to safe abortion services. Studies conducted by IPAS, a non-governmental organization focusing on reproductive health, have shown that unsafe abortions account for 25 percent to 50 percent of maternal deaths among refugee populations.

The moral imperative to aid refugees is unquestionable. However, there is also more than 50 years of international recognition in treaties and agreements of the need to provide women and girl refugees with reproductive health services and protection from sexual violence. The Center for Reproductive Rights' briefing paper, "Displaced and Disregarded: Refugees and their Reproductive Rights" identifies the support for reproductive rights laid out in international agreements.

Under the International Covenant on Economic, Social and Cultural Rights, "Special protection should be accorded to mothers during a reasonable period before and after childbirth." Recognition of refugees’ rights, particularly their health needs, appear in the document produced at the UN's 1994 International Conference on Population and Development. Which states, "Refugees should be provided with access to adequate accommodation, education, health services, including family planning, and other necessary social services."

A more in-depth discussion of the international legal and policy support for refugees’ reproductive rights appear in the Center for Reproductive Rights' briefing paper.

Mexican Supreme Court Upholds Abortion Rights On Some Grounds

In late January, the Mexican Supreme Court upheld a federal district law permitting women to obtain an abortion in cases of rape or "proven" instances of severe fetal deformity.

"There is still a long way to go," said Luisa Cabal, a Center for Reproductive Rights staff attorney. "but the Supreme Court's decision to uphold the reform that makes Mexico's abortion law more flexible is a step in the right direction towards the recognition that women should have the legal right to choose."

The court decision also reduced the maximum sentence for obtaining an illegal abortion from five years in prison to three. Abortion is illegal in all but a few cases in Mexico's 31 states and in Mexico City.

Spain Rejects Abortion Law

In February, the Spanish parliament rejected by a single vote a proposal that would have liberalized its abortion law, one of the most restrictive in Europe.

"Spain, thus, continues to remain behind almost all other European nations in guaranteeing a woman's right to free choice," said Christina Zampas, a Center for Reproductive Rights staff attorney. "Spain is compromising the health of its women by denying women access to safe, legal abortion services."

The proposal would have allowed women to terminate their pregnancies if they were suffering grave personal or economic problems. Under Spanish law, women can obtain a legal abortion only in cases of rape, fetal impairment, and threat to physical and mental health. Abortion was legalized under these conditions in 1985.

Similar bills have been rejected three times since the conservative Popular party took control of the parliament in 1996.

On the Hill

Bush 2003 Federal Budget Proposal Neglects Reproductive Health

In February, the Bush Administration unveiled its 2003 federal budget proposal demonstrating its hostility toward successful reproductive health care programs at home and abroad.

The Administration is seeking a $33 million funding increase for abstinence-only sex education grants for community based organizations, bringing the total federal support to $73 million. It also wants to renew a $50 million a year program under the 1996 welfare reform law that provides grants to schools for these programs that, among other restrictions, do not include discussion of contraceptives in their curriculum. The Administration has also proposed $10 million - a flat level from 2002 - for the Adolescent Family Life program's abstinence-only education programs.

At the same time, the Administration does not want to increase Title X family planning program funding above its 2002 level of $266 million. For more than 30 years Title X has been crucial to ensuring women have access to family planning services. The program provides contraception, counseling for infertility and prenatal care information, educational programs to inform and promote participation in Title X services, and treatment of sexually transmissible infections.

Despite the Bush Administration's lofty rhetoric supporting the freedom and health of Afghan women during the war on terrorism, its real intentions come to light in the 2003 budget proposal. President Bush, who is already holding hostage funds for the UN Population (UNFPA) approved by Congress, has proposed no funding for the UN agency in 2003. UNFPA is the leading provider of reproductive health care services for women in many of world's most hostile lands.

In addition, the budget does not define the amount of support for the U.S. Agency for International Development's (USAID) family planning programs. Informally, reproductive rights activists have heard that $425 million is the most likely level - a drop of $21.5 million from last year. In 1995, the USAID family planning assistance was $541.6 million and plummeted to $356 million in 1996. Research organizations conservatively estimated that this 35% reduction in funding resulted in 4 million unplanned pregnancies, 1.6 million abortions, 8,000 maternal deaths, and 134,000 infant deaths due to increased high-risk births.

Center for Reproductive Rights Joins 77 Organizations To Oppose Abstinence-Only Funding

The Center for Reproductive Rights joined 77 other organizations in writing a letter to oppose the Bush Administration's budget proposal to increase funding for abstinence-only sex education.

The groups stated that funds should be allocated to "science-based sexuality education that includes age-appropriate, medically accurate information" about abstinence and contraception.

Abstinence-only sex education urge adolescent boys and girls to not engage in sexual intercourse before marriage without advising young people about contraception and other reproductive and sexual health issues. The Bush administration is proposing $135 million for abstinence-only education next year, an increase of $33 million.

"There is little scientific evidence that [abstinence-only] programs ... are effective," stated the letter. "Continued increases to these unproven programs fly in the face of both scientific evidence and the desires of parents."

The groups included the National Abortion and Reproductive Rights Action League, the Planned Parenthood Federation, the American College of Obstetricians and Gynecologists, and the American Medical Association, among others.

BRIEFLY:

In February, U.S. Secretary of State Colin Powell clearly stated his support for sexual education programs that include discussion of both contraceptives and condoms.

Secretary Powell stated on a televised program on MTV, when asked about his view on the Roman Catholic church's opposition to condom use, that "condoms are a way to prevent [HIV] infection, and therefore, I not only support their use, I encourage their use among people who are sexually active."

He reaffirmed these statements two days later after coming under fire from conservatives. He stated on CNN's "Late Edition," "I have no apology for the way in which I answered the question."

On NBC's "Meet the Press", Powell stated it is time "for us to speak out clearly and responsibly to help millions" of youngsters around the world, such as the audience he was talking to - ages 17 to 25.

He added, "if they are going to be sexually active, we've got to educate them how to protect themselves. And one way to do that is with condoms. And for me to have said anything else would have been irresponsible."

Anti-choice Lawmakers Support Abortion Travel Ban Bill

Anti-choice lawmakers in a House subcommittee supported, for a third time, a bill that would make it a crime for anyone other than a parent to take a minor across state lines to obtain an abortion if the minor's home state has a law that requires parental notification or consent.

The House Judiciary Subcommittee on the Constitution approved the bill, known as the Child Custody Protection Act (CCPA), in early February.

"This bill does not protect children: it endangers young women seeking abortions by forcing those who can neither involve their parents nor face a judge to take matters into their own hands," said Rosemary Dempsey, Center for Reproductive Rights Director of Government Relations. "Many young women will travel alone or even risk an unsafe abortion rather than their parents' disapproval or anger."

The Center for Reproductive Rights opposes CCPA as an unconstitutional violation of the right to choose. Its provisions create an undue burden on a young woman's right to obtain an abortion. The bill provides no health exception as mandated by the Supreme Court beginning with Roe v. Wade and reaffirmed by Stenberg v. Carhart in 2000.

The bill is not a federal version of the forced parental involvement laws in effect in some states. Rather, it would force a minor to comply with her own state's law in addition to any requirements in the state in which she sought an abortion, or risk prosecution of anyone who accompanied her. Minors traveling alone do not face a penalty.

In order to be sure that a non-parent traveling with her will be safe from prosecution, a young woman would have to assess the law in the state in which she will be having the procedure as well as her own state law, comparing both of these with CCPA. This "transference" of the law of one state onto activities to be performed in a second state is an unprecedented violation of the Constitutional principles of federalism.

"Parent" is defined narrowly in the bill, ignoring the fact that other adults may play a parental role in minor's lives. Grandparents, clergy, teachers, coaches and counselors would risk prosecution if this bill becomes law. Studies have shown that a majority of young women talk to their parents about an unwanted pregnancy. Those who do not may have a legitimate fear of violence or other problems.

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