Arkansas is the perfect place to try out this new health trend. Read all about the what, why, where and how here.
Before Roe v. Wade, there was "Bloody Mary."
Women who lived in Arkansas in the 1960s and whose friends had had abortions (or who'd had them themselves) will remember the woman who for a couple hundred dollars would terminate an unwanted pregnancy.
"Bloody Mary" wasn't a health professional. She lived on Lake Hamilton and performed abortions in her home there. A woman this reporter interviewed recently remembered driving one of her friends there.
She and the others who made the trip — including the father — dropped off their friend at a house where, the woman remembered, a Confederate flag flew. The abortionist herself wore overalls and a hat with a Confederate flag on it. The crew — all teen-agers — nervously drove around a bit before going to back to pick up their friend.
"She'd been stuffed with gauze way up," past the cervix, the woman recalled.
"She was having incredibly painful contractions and bleeding all over the place." They got her back to Little Rock, and though she tried to keep her situation from her parents, the bleeding was massive. She had to go to the hospital, suffering from infection and blood loss. "Bloody Mary" had apparently used instruments to force open the cervix and wedged in "tons of gauze, multiple rolls," the girl told her friends.
"The very doctor who had sent her to the abortionist had to take over her care," the woman recalled.
"Bloody Mary" is no myth, and she wasn't the only abortionist to endanger a girl's life with a botched abortion. This writer, too, knew high-school girls who visited an abortionist, with life-threatening outcomes.
Rose Mimms, the head of Arkansas Right to Life, shook her head sadly when she heard the stories. Abortion is as old as mankind is, she said. If she succeeds in her battle to make abortion illegal again, yes, she said, women will still seek abortions and, yes, they might suffer. She recalled her mother talking about women using knitting needles, and that the expression was "to knock these babies."
But she dismisses claims made previously that thousands could die. And she believes legal abortion is dangerous, too. "They'll die regardless."
And, in Mimms' view, thousands of unborn children will live. No longer will women thwart the Father's will, the plan He has for every fetus conceived.
Those who support the right of a woman to decide whether or not to carry her pregnancy to term were relieved that legislators thwarted the will of Arkansas Right to Life and other anti-abortion lobbyists in this year's General Assembly, turning back eight of nine bills that would have further limited access to what is now a legal procedure.
But Right to Life and the Family Council have successfully chipped away at access to legal abortion in Arkansas, one of only 13 states to have made abortion legal prior to the Supreme Court's decision in Roe v. Wade in 1973.
Arkansas law allows abortion up to the first day of the 26th week of pregnancy, or in cases of rape, incest or to save the life of the mother. Minors must get consent or a judicial bypass, except in the case of abuse, assault, incest or neglect.
At one time, there were several physicians in private practice in Arkansas who would perform an abortion, and a clinic affiliated with the University of Arkansas for Medical Sciences offered the procedure as well. In recent years, only Dr. William Harrison in Fayetteville and Little Rock Family Planning Services offered surgical abortions. With Harrison's death, there is now only one place to get a surgical abortion.
With the approval of RU486, however, Planned Parenthood clinics in Fayetteville and Little Rock have begun to provide medical abortions — a service the organization says only 10 percent of its patients come to them for. Right to Life claims to have stopped Planned Parenthood expansion into other cities in Arkansas.
The sometimes violent protests at women's clinics by the Army of God, Operation Rescue and other extremist groups — which included murder and attempted murder of doctors and nurses, bombings, arson and other forms of intimidation — increasingly scared off providers, though the national Right to Life condemned the murder of Dr. George Tiller, at his church, in 2009, the last doctor to be killed for providing abortion.
Increasingly, it's state and federal legislation that has undermined the extent to which legal abortion can be obtained. Since the court ruled on Roe, federal and state governments have withdrawn all dollars for abortion and legislatures have passed laws requiring parental notification or consent, waiting periods, forced viewings of ultrasounds, overregulation of clinics, limitations on private insurance coverage and other roadblocks to the current constitutional right to abortion. Courts all over the country are tied up in litigation over state laws that would further block access.
Arkansas Right to Life would ban all abortions, except, director Mimms says, to save a woman's life.
Though the organization favors all pro-life legislation, Arkansas Right to Life concentrates its efforts on "bills that have a legitimate chance" of passage, Mimms said. Of the three bills it actively supported, only one passed. A rundown:
SB113. Rogers Republican Sen. Cecile Bledsoe introduced a bill that would have prohibited companies participating in health insurance exchanges from covering abortion. (Under the Health Care Affordability Act, states have until 2014 to create the exchanges, meant to serve individuals and small businesses that can't now afford insurance coverage.) Bledsoe and her supporters argued that the bill would make sure no federal dollars paid for abortion, but the reproductive rights coalition pointed out that federal law already exists to prevent taxpayer dollars to go toward abortion. The bill would have curtailed what private pay insurers would do, they said.
Arkansas Right to Life intends to bring this bill back in 2013, since the state has until 2014, under the Health Care Affordability Act, to create the exchanges, designed to help people who could not otherwise get insurance. Mimms was surprised that the bill, which passed the Senate but, like all but one of the other bills, died in the House Committee on Public Health, Welfare and Labor. "I thought it was a no-brainer," she said. She said women could take out a rider (though none exist) to pay for coverage in case sometime in the future they might want an abortion, like a cancer policy.
HB1887. Rep. Andy Mayberry, a Republican from Hensley, introduced a bill that would have made abortion at 20 weeks gestation or later illegal, on the theory that fetuses can feel pain at that point. That would cut the window of availability by 5 weeks.
Included in the bill's language was the claim, based on "new studies," that indicate that neural development is such that that the fetus can feel pain at 20 weeks. It includes the information that doctors who perform surgery on such fetuses (like spina bifida surgery) use anesthetics.
State law already requires abortion providers to provide women with information stating that at 20 weeks, the fetus reacts to stimuli that "in an infant or adult would be interpreted as a response to pain" and noting that anesthesia is administered to fetuses at 20 weeks who are to undergo prenatal surgery.
A study published in the Journal of the American Medical Association, however, concludes that fetal neural development doesn't reach a stage at which pain is recognized until 27 to 30 weeks, and doctors say the reason pain killers are used in fetal surgery is to keep the fetus immobile and the uterus relaxed.
The bill also would have allowed parties other than the patient to sue a physician who violated the law. That would have given standing, for example, to a rapist whose victim was seeking an abortion.
The bill got a "do pass" on a voice vote in the House public health committee, but failed 9-3 on a roll call vote.
Right to Life director Mimms said committee chair Rep. Linda Tyler of Conway would not initially allow Mayberry to use a PowerPoint presentation depicting fetuses in various states of gestation, but agreed to put it to a voice vote at the next meeting. At the next meeting, Tyler called the vote when the committee attendance reached a quorum and Mayberry's proposal "went down in flames," Mimms said. "Half the members weren't there," Mimms said. "I'm sure they've got good excuses for being late," she said wryly.
Mimms said pro-lifers would make sure that Tyler's "feet will be held to the fire" at the next session. Yet, she also believes that Tyler was being controlled by higher forces — "the governor, the AG [attorney general], somebody."
HB1855. The only anti-abortion legislation to pass this year, the bill, now Act 1176, requires facilities that provide more than 10 abortions per month to be licensed by the state. Planned Parenthood objected to the bill because abortion providers are already regulated by numerous federal health agencies and state and local safety codes. The state Health Department is formulating proposed licensing rules now; the rules should be ready for review in July, according to the department.
State Rep. Bruce Westerman (R-Hot Springs) introduced a bill that would have made it illegal for all state facilities to abort abnormal fetuses. Only the University of Arkansas for Medical Sciences would have been affected by the bill. The bill, which would have made an exception for the life of the mother, failed on a voice vote.
Westerman talked to Dr. Curtis Lowery, chair of the department of obstetrics and gynecology at UAMS, before introducing his bill, but it's unknown if the legislator talked to any women.
The bill was vague enough, Lowery said, that, for example, it might have prevented doctors from operating on a woman who had a premature rupture of the membranes surrounding the fetus. The fetus would have zero chance of survival, he said; without the operation, the woman would risk infection.
The bill would have required women to carry to term fetuses with fatal abnormalities. That's tantamount to "forcing a mother to face [the risk of delivery] for a baby that would not have a chance of survival," Lowery said.
Ravina Daphtary, a regional coordinator for the women's reproductive rights group Raising Women's Voices, did not, of course, support the bill. But she gave Westerman credit for doing some research. "His candor about the difficult choices these families face was so refreshing," she said. He "demonstrated a level of empathy that is rare among male, pro-life legislators in Arkansas."
On the other end of the spectrum, state Rep. Missy Irvin, a Republican from Mountain View, introduced a bill that would have required doctors to prescribe abortion-inducing drugs at a dosage three times the amount that's been proven effective. When the FDA approved the drug RU486 (mifepristone) in September 2000, the recommended dosage was 600 mg. But relying on evidence from data on drug regimens generated worldwide, doctors have cut the dosage by a third, prescribing it "off-label" at 200 mg. (Prescribing off-label is a common practice.) Irvin's bill, which passed the Senate, would have meant women had to pay triple the price and face a risk of more side effects, the reproductive rights side said.
Pro-lifers maintain RU486 is dangerous, and cite 12 deaths in the decade it's been in use. Pro-choicers would argue that far more women die in childbirth.
Ironically, Irvin had argued in her presentation of a prior bill that physicians needed to have control over the treatment of a patient, a contradiction pointed out to her by a fellow legislator during testimony on her mifepristone bill.
Other failed bills would have required providers of surgical abortion — there is only one in Arkansas — to build an "ambulatory surgical facility," an expense that could put a provider out of business; and required a woman to be informed of her fetus' heartbeat and the statistical probability of successfully carrying the fetus to term, and sign a form attesting to that; made it a criminal offense for a doctor to not provide women with state-produced materials on abortion, materials considered as biased by pro-choice forces. There was also a House bill on health exchanges identical to SB113.
In the 2013 session, Right to Life will push for legislation to ban what Rose Mimms calls "webcam abortions." She's referring to the use of telemedicine to allow satellite clinics to prescribe medical abortifacients. That would make abortion accessible "in every part of the state," and she called it the future of abortion. While telemedicine is used in other situations to bring health care to areas lacking a doctor, Mims said pregnancy is "not just another medical condition."
On the federal level, Arkansas Republican Sen. John Boozman has another anti-abortion tactic up his sleeve. He will introduce legislation that would not allow minors to cross state lines to get an abortion without proof their parents have been notified, and sets a four-day waiting period. Only those in a medical emergency or who can offer "clear and convincing evidence of physical abuse" by a parent during those 96 hours would be exempt. It also sets criminal penalties for violation of the law.
Rita Sklar, director of the American Civil Liberties Union of Arkansas, praised the open-mindedness she witnessed among some legislators during the session. "I was happy to see several committee members who wanted to learn more about how legislation really impacted women and women's health." Did the pro-choice proponents change any minds? "I think so. When they learned the truth about what a bill would do, some verbally expressed surprise — 'You mean this bill wouldn't do anything?' " She said bills that were "purely political plays" made them mad. Some legislators were sincere in their religious or moral objections to abortion; some didn't think it was the government's business. Debate "renewed my faith in the political process," she said.
"Women's bodies are used as a political football and it's time that stopped," Sklar said. Lawmakers need to address issues more appropriately in the government's domain.
Even Arkansas Right to Life concedes that making abortion illegal, its goal, wouldn't stop abortion, though director Mimms believes most women will abide by the law.
Dr. James Romine, a Fayetteville obstetrician in practice for around 40 years, worries that should the Supreme Court overturn Roe v. Wade, women will again need hospital care for septic abortions, and he wonders if physicians will be trained to treat it.
In 1965, prior to legalized abortion, Romine did an obstetrical rotation at Grady Memorial Hospital in Atlanta, a 1,000-bed charity hospital. An entire ward was devoted to care of women who'd developed sepsis from criminal abortions.
"They would present with sepsis or fever and infection and bleeding. ... Those required high-dose antibiotic therapy and evacuation of the uterus and at times some teen-agers had to have complete hysterectomies," Romine said.
He saw women who'd inserted slippery elm into the cervix. Coathangers still in the uterus. Eroded vaginas from potassium permanganate, a common illegal abortifacient; "I saw a 15-year-old bleed to death from that." He saw two patients die from septic shock and scrubbed in on several hysterectomies necessary in cases of severe infection. The abortionists didn't "operate under the germ theory," he said.
With abortion legal, back alley abortions have largely disappeared, though UAMS did treat one case in the past 12 months. It's more common that women try to self-induce; doctors here have seen girls who've drunk turpentine and other chemicals, used herbal remedies or ordered phony medications online.
Romine's practice in Fayetteville did not offer abortion. "It didn't mix with" ob/gyn, he said. But Dr. William Harrison did, and was an outspoken proponent of a woman's right to choose. He died last year, leaving Northwest Arkansas without its only surgical abortion provider (and reducing the number of Arkansas providers by half).
Though the reasons for it are unclear — whether lack of access or a decline in pregnancy — abortion in Arkansas is declining. There were 5,500 abortions reported to the state Health Department in 2000, compared with 4,532 in 2010 for a much larger population. Since 2003, when the department started reporting its data on teen-agers by individual age (rather than cumulatively), abortions performed on teens 17 and under dropped from 438 to 285 last year. The age group in which abortion is most common — ages 20 to 24 — has declined at a somewhat slower rate, from 1,905 in 2000 to 1,455 in 2010.
There are some possibly ugly numbers in the department's records. Minors must have their parents' consent or a judicial bypass to get an abortion in Arkansas, but there is an exception for medical emergencies, if minors have been abused, assaulted, raped or the victims of incest or neglect, or if they have been declared emancipated, usually because they've already borne a child. In 2010, 67 girls fell into that category. That's the highest number since the department started keeping data on girls requiring parental consent in 2005. It is not possible to tell from the data how many girls who did not receive their parents' consent did not seek a judicial bypass and gave birth.
The Arkansas Health Department, even without legislative pressure, limits access to abortion in its own way, by not providing a contraceptive that Right to Life groups contend is an abortifacient. The medication Plan B, which inhibits ovulation (in the same manner that doubling up on birth control pills after unprotected sex does), is considered by right-to-life groups as an abortifacient. There is a gray area, depending on how quickly the pill is taken after sex: If it's taken after an egg is fertilized in the fallopian tubes, it works by keeping the zygote from attaching to the uterine wall.
The department does provide other forms of birth control — including the IUD, which acts in the same manner that Plan B does, by making the uterine wall hostile to implantation.
Murry Newbern, director of community affairs for Planned Parenthood of Arkansas, is frustrated by the demonization of the organization. "Over 90 percent of what we do is not abortion. It's preventive." She wishes anti-abortion groups like the Family Council and Right to Life would put as much energy into preventing unintended pregnancy as they do into blocking access to what is a legal procedure.
The family planning organization has been able to fend off the current attack from Republicans in Congress who want to end all federal funding. Since no federal dollars may be spent on abortion, that means that what Congress would actually be cutting is health care for the poorest women in America. In Arkansas, half of Planned Parenthood's clients rely on Medicaid for clinic reimbursement.
Newbern noted that churches get federal money on the premise that they won't spend any of it proselytizing "and the government trusts them." She said the government does thorough audits of how Planned Parenthood spends its money; lawmakers — the majority of them men — must know their proposal would mean fewer women would receive pap smears, breast exams, sexually-transmitted disease tests, birth control and other care.
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