I have steered well clear of abortion as a topic. It stirs tremendous emotions, which in turn lead people to be verbally assaultive and violent, and sometimes physically violent. People end up hating, really hating others over abortion values. Despite all this, I am going to say a few things about abortion, prompted by the recent Texas court case, which you can read about here.
Very briefly, a new Texas law denies state funding to organizations that perform abortions, while otherwise funding women's health care clinics completely. Federal funds used to provide 90% of the budget for women's health care clinics, but that is changing. The Texas law picks up the funding slack (it isn't much money) while denying funds for any clinic that performs abortions.
There was a similar news story last year about funds from the Susan Komen Foundation being used to support abortion services. That story got buried pretty quickly in the general desire to support SGK's overall mission to fund mammograms and reduce breast cancer incidence.
These stories have nothing to do with support or opposition to abortion. Rather, they relate to the public perception of abortion services. Here there is a divide as stark as approval of elective abortion. For most people, the Bush Terrorism Doctrine applies. If you fund abortions, train people to do abortions, have facilities to do abortions or actually perform abortions, then you are an abortion clinic. Everything else you do is irrelevant. You are an abortion clinic.
Is that fair? Of course not. Planned Parenthood is one of numerous providers of outpatient women's healthcare. These clinics fill an essential healthcare role. They provide paps, birth control education and information and in some cases prenatal care for women who have no insurance at all and are low income.
In most doctors' offices if you come in with no insurance you are charged the full fee for an annual exam. In Tennessee that is about 240.00, plus another 29.00 from the lab for the pap. Most women without insurance can not afford this. The various health clinics provide service on a sliding scale all the way down to zero for low income women. They often provide other services as well- psychological counseling and evaluation, STD testing, pregnancy testing, colposcopy and nutritional evaluation.
These are very important social services, and the sort of use of Federal tax money that I support and I think most people support. But the Federal funds don't cover abortion services. Some clinics separate their abortion services into a separate building, sometimes with completely separate administration and books, in order to show complete separation of funds.
Despite this, any clinic that offers abortion services gets labeled very quickly as an abortion service. This label is so strong and so polarizing that these clinics rapidly fall into a completely different consortium of providers, the National Abortion Federation. And feelings about this are so strong that while every county in the US has a health department, and many have low cost clinics for women's care, only a very few, less than 10% of counties, have an abortion provider.
I am a gynecologist. I started my career in the northeast, where there is acceptance and tolerance of abortion. I was trained in part by a man who was a member of the International Executive Board of Planned Parenthood. But even in the northeast there are very few gyns who do OB, regular gyn and abortions. You rapidly get labeled an 'abortion doctor', and this in an area openly accepting of abortion services, not Texas, or Tennessee. The man who helped train me had an enormous abortion practice, a referral practice for abortion, but only a small gyn practice and an even smaller OB practice.
George Bernard Shaw once asked a woman at a swanky party if she would sleep with him for 10,000 pounds. She smiled and said yes. He then asked if she would sleep with him for a shilling, to which she replied 'what kind of woman do you think I am'. He said 'we've already established that. All we're doing is haggling price.'
Like the Bush doctrine, like the woman in the Shaw story, the moment you become involved in providing abortions, you are an abortionist, not an obstetrician. And it interests me that this labeling applies even in areas strongly supportive of abortion access like New York. As a result of that labeling, if you perform abortions you are not going to get public money in many places.
Whether this is just or an outrage is a matter of strongly held opinion, but the fact of the separation of abortion and other women's services is recognized in society, medicine and, in Texas, law. It is a question worthy of personal reflection and moral consideration WHY this separation exists, but it does, and therefore must be considered by any person or clinic providing women's services.
Whether you like it or not, if you provide abortion services, you are an abortion provider. And that's one hell of a defining label.
Ted
Very briefly, a new Texas law denies state funding to organizations that perform abortions, while otherwise funding women's health care clinics completely. Federal funds used to provide 90% of the budget for women's health care clinics, but that is changing. The Texas law picks up the funding slack (it isn't much money) while denying funds for any clinic that performs abortions.
There was a similar news story last year about funds from the Susan Komen Foundation being used to support abortion services. That story got buried pretty quickly in the general desire to support SGK's overall mission to fund mammograms and reduce breast cancer incidence.
These stories have nothing to do with support or opposition to abortion. Rather, they relate to the public perception of abortion services. Here there is a divide as stark as approval of elective abortion. For most people, the Bush Terrorism Doctrine applies. If you fund abortions, train people to do abortions, have facilities to do abortions or actually perform abortions, then you are an abortion clinic. Everything else you do is irrelevant. You are an abortion clinic.
Is that fair? Of course not. Planned Parenthood is one of numerous providers of outpatient women's healthcare. These clinics fill an essential healthcare role. They provide paps, birth control education and information and in some cases prenatal care for women who have no insurance at all and are low income.
In most doctors' offices if you come in with no insurance you are charged the full fee for an annual exam. In Tennessee that is about 240.00, plus another 29.00 from the lab for the pap. Most women without insurance can not afford this. The various health clinics provide service on a sliding scale all the way down to zero for low income women. They often provide other services as well- psychological counseling and evaluation, STD testing, pregnancy testing, colposcopy and nutritional evaluation.
These are very important social services, and the sort of use of Federal tax money that I support and I think most people support. But the Federal funds don't cover abortion services. Some clinics separate their abortion services into a separate building, sometimes with completely separate administration and books, in order to show complete separation of funds.
Despite this, any clinic that offers abortion services gets labeled very quickly as an abortion service. This label is so strong and so polarizing that these clinics rapidly fall into a completely different consortium of providers, the National Abortion Federation. And feelings about this are so strong that while every county in the US has a health department, and many have low cost clinics for women's care, only a very few, less than 10% of counties, have an abortion provider.
I am a gynecologist. I started my career in the northeast, where there is acceptance and tolerance of abortion. I was trained in part by a man who was a member of the International Executive Board of Planned Parenthood. But even in the northeast there are very few gyns who do OB, regular gyn and abortions. You rapidly get labeled an 'abortion doctor', and this in an area openly accepting of abortion services, not Texas, or Tennessee. The man who helped train me had an enormous abortion practice, a referral practice for abortion, but only a small gyn practice and an even smaller OB practice.
George Bernard Shaw once asked a woman at a swanky party if she would sleep with him for 10,000 pounds. She smiled and said yes. He then asked if she would sleep with him for a shilling, to which she replied 'what kind of woman do you think I am'. He said 'we've already established that. All we're doing is haggling price.'
Like the Bush doctrine, like the woman in the Shaw story, the moment you become involved in providing abortions, you are an abortionist, not an obstetrician. And it interests me that this labeling applies even in areas strongly supportive of abortion access like New York. As a result of that labeling, if you perform abortions you are not going to get public money in many places.
Whether this is just or an outrage is a matter of strongly held opinion, but the fact of the separation of abortion and other women's services is recognized in society, medicine and, in Texas, law. It is a question worthy of personal reflection and moral consideration WHY this separation exists, but it does, and therefore must be considered by any person or clinic providing women's services.
Whether you like it or not, if you provide abortion services, you are an abortion provider. And that's one hell of a defining label.
Ted
Indeed. What happened to the Ob-gyn who trained you is what happens to some extent to most medical specialists: referral patterns and reputation become entrenched so that the focus of one's practice is a sub-specialty within the broader specialty. I've seen this happen within the field of general surgery, where a doc becomes a "breast" surgeon, "endocrine" surgeon, or "vascular" surgeon and therefore rarely (if ever) receives referrals in other areas where he/she also has expertise.
ReplyDeleteIt's not just the U.S. where this issue is politically charged. In Ecuador, for example, where abortion is illegal (but widely performed) the Ecuadorian congress is currently debating whether to legalize abortion in cases of rape or incest; and the dividing lines - both in congress and in the country - are clearly drawn, with opinions being so strong as to not encourage any sort of moderation of viewpoints.
My own opinion with respect to the funding of women's care centers and abortions is that if a state votes to withhold funding for abortions, that is one thing, but to withhold funding for an entire clinic that includes abortions among its many services is not wise.
-D-