Why Birth Control Shouldl Not Be Covered by Health Insurance: A Pro-Women’s Rights Take

On Tumblr earlier today, I posted a short piece against health insurance coverage for birth control. Mind you, I was not opposing birth control as such, or the idea of women who can’t afford it, getting birth control paid for. What I was saying, was that birth control is not a health issue, and therefore should not be covered through health insurance.

So why is it not a health issue? I acknowledge that it is, in some cases. For example, some women use birth control to prevent premenstrual symptoms or to lessen the risk of ovarian cysts. However, most women use birth control for its intended purpose, which is contraception. And while the right to prvent pregnancy, is a women’s right, it is not a health issue.

So what is it? It’s a matter of reproductive justice and of sexual liberty. Women (and men and people of all genders for that matter) have a right to consensual sex however they please, and this is the reason most people use birth control, and have every right to do so. Making sexual rights about health, however, distracts people from the real point of the discussion, which is that people of all genders have a right to do sexually as they wish as long as they obtain consent from the other people involved. Too often, liberals and feminists, indeed, use tragic examples of the health uses of birth control to draw attention to the need for coverage, but these needs can easily be met without having to admit that every woman has a right to birth control.

Then there is the thing that contraception should not be covered by insurance. The reason behind this is more based on what insurance is for, which is to cover the costs of unforeseen risk. Birth control is, however, there to deal with in most cases a calculated risk. (I know that in cases of rape and incest, this is not true, but these make up the minority of birth control uses.) Women know whether they want to get pregnant, so when they purchase health insurance, their need for birth control is known to them. Besides, we have insurance systems to cover relatively small risks, while in the case of birth control, 99% of all American women have used it in their lifetime, if we have to believe Sen. Gillibrand, which I do. That’s such a substantial number that it’s not something insureable.

On my Tumblr, people commented that men get Viagra paid for through the health insurance industry, too. I at first found this a valid argument, but my husband, with whom I discussed my Tumblr post and its responses, reasoned otherwise. He said that erectile dysfunction is not natural, while getting pregnant after unprotected sex is. I am not sure I agree with this logic, which is based in what it’s meant to be a functioning human.

However,the Viagra comparsion goes awry in one respect, which is what I mentioned above: erectile dysfunction is much less common, and much less calculable, than pregnancy after unprotected sex. Therefore, even if you reason that it’s not a medical problem and therefore doesn’t need health insurance coverage, it could still fulfill the other principles insurance is based on, and people may for example opt to buy additional coverage for this purpose.

Note, again, that I never said that women should have to pay for birth control out-of-pocket just because it’s not an insureable risk or a health matter. My husband proposed, and I agree with this, that there should come some kind of low-income fund, which would pay for birth control for women who can’t afford it otherwise. After all, I am totally for birth control to be affordable to all women.

Read Full Post »

Born Unwanted: Psychosocial Consequences for Children Whose Mothers Were Denied Abortion

Abortion is, of course, a vjery controversial but relatively common means of fertity planning. A lot of research has been done on various aspects of it, such as mental health and medical consequences of abortions as compared to completed pregnancies. However, little research has been done on the consequences of completing an unwanted pregnancy for the resulting child. In the American Journal of Orthopsychiatry, april 2011, there is a very interesting study on this topic.

The study compared mental health and developmental outcomes for children whose mothers were denied abortion to those born from accepted pregnancies. In Prague in the 1960s, abortion had to be approved by a local abortion commission, and, if denied, could be approved anyway by a regional commission. Unwantedness was defined for the purposes of this study as an abortion having been denied twice. This is a very strict definition of unwantedness, because, of course, not all unwantedly pregnant women go through the bureaucratic process of twice requesting abortion.

There were 220 unwanted pregnancy children found eligible for the study. Each was pair-matched to a child from an accepted pregnancy (mother’s name did not appear on the abortion record) similar in age, gender, birth order and school, while mothers were matched on age and socio-economic status. Children were followed up at age 9, 14-16, 21-23, 28-31 and 32-35. In addition, a substudy was done on married people at age 26-28.

Children born out of unwanted pregnancies had similar birth weights and lenghts, a similar chance of having congenital abnormalities, and a similar score on signs of minimal brain dysfunction (a condition most like current ADHD) to the accepted pregnancy children. At age 9, the two groups also scored similar on overall IQ. However, the unwanted pregnancy children, particularly boys or only children, were significantly less sociable and well-adjusted than the controls.

In adolescence and young adulthood, problems for the unwanted pregnancy group became more significant as compared to the controls. In adolescence, unwanted pregnancy children had dropped out of school more and had obtained lower scores in school (that is, much fewer scored above-average). Social problems also continued. In young adulthood, fewer unwanted pregnancy people were satisfied with their jobs, relationships and overall mental well-being than accepted pregnancy people. Mothers were also less satsified about their unwanted pregnancy children’s developmental and educational outcomes. More unwanted pregnancy children than accepted pregnancy children had been or were still in treatment for mental health conditions, and also more unwanted pregnancy children had been sent to prison.

By about age 30, there was still a difference in psychosocial adjustment between people born from unwanted pregnancies and accepted pregnancies. However, this gap had narrowed. By this follow up, women’s outcomes were less favorable as compared to controls than men’s. There was a significant difference between unwanted pregnancy women and control women in terms of unemployment, unmarried status, and parenting difficulties that requered authority attention, to the disfavor of the unwanted pregnancy women. Such a difference could not be found among men. Unwanted pregnancy women were also less socially integrated and emotionally stable than controls. These effects were due to unwantedness. This can be seen, because, by this stage in follow up, siblings were used as an additional comparison group, and they did not show these problems.

Lastly, by age 32-35, those unwanted pregnancy and accepted pregnancy people still living in Prague and their siblings were given an extensive face-to-face interview. Mental health outcomes were compared. People born from unwanted pregnancies had significantly more problems, as indicated by nine out of ten measures of mental health – ranging from inpatient treatment to sexual satisfaction – than their siblings. This difference was not found among the accepted pregnancy people. The unwanted pregnancy people were significantly more likely to have received inpatient and outpatient mental health treatment than the accepted pregnancy people. They were also significantly more likely to suffer from anxiety and depression. By this age, however, poor social adjustment was not merely attributable to unwantedness, since siblings of unwanted pregnancy people also had poorer social outcomes than the accepted pregnancy controls’ siblings.

The substudy on married unwanted and accepted pregnancy people found some interesting things. In many ways, the female partners of unwanted pregnancy men and the male partners of unwanted pregnancy women were comparable to unwanted pregnancy women and men, respectively. Female partners of unwanted pregnancy males had more abortions (both one-time and repeat) and were more dissatisfied with their jobs and mental well-being than the famele partners of male controls. Similarly, male partners of female unwanted pregnancy people encountered more relationship difficulties than the male partners of control females. Lastly, unwanted pregnancy women who had at least one child, felt less prepared for and less happy about the pregnancy and parenthood than control females.

This study, the author concludes, shows that unwanted pregnancy and denial of abortion lays the foundation for an environment in which children are poorly reared, which subsequently leads to mental health and psychosocial problems for the unwanted child. An alternative hypothesis, whereby mothers of unwanted pregnancy children are simply emotionally unavailable mothers, is rejected.

The last wave of the Prague study was conducted in 1996/1997. The results of earlier waves of this study, in part, led the Czech government to abolish abortion commissions in 1986. The author of course advocates legal abortion and other means of fertlity regulation. It is interesting that this is argued from the point of view of the unwanted child, who is at significant risk of mental health and psychosocial problems if born. Of course, it remains to be debated, from an anti-abortion standpoint, whether these problems are worse than not to be born.

Reference

David HP (2011), Born Unwanted: Mental Health Costs and Consequences. American Journal of Orthopsychiatry, 81(2): 184-192. DOI: 10.1111/j.1939-0025.2011.01087.x.

Read Full Post »

Saving Lives Act: Ending Lives

Jill over at Feministe has an excellent commentary on a new bill introduced in the U.S. House of Representatives that would allow doctors to refuse therapeutic abortions even in life-saving cases. Thomas over at Blog for Choice also posts some commentary and links to further information. Whether you are pro-choice or pro-life, you should oppose this bill. After all, if the prgnant woman dies from lack of proper care, her fetus dies, too. I encourage all my U.S. readers to call their representatives to prevent the passage of the Ending Lives Act, as I call it.

Read Full Post »

GOP Knows Best Whether You Were Raped

Over at Feministe, there is an excellent post summarizing the anti-reproductive rights proposals made in H.R. 3, the so-called No Taxpayer Funding for Abortion Act. Most strikingly, the Republican Party, who obviosuly sponsors this bill, seeks to redefine rape for the purposes of abortion access. Only victims of “forcible” rape will be able to obtain an abortion through taxpayer-funded insurance. This term is not defined, but it is assumed that a victim cannot have been asleep, intoxicated, unconscious, or otherwise not fighting against the rape. I’m not sure whether spousal rape is considered “forcible”, but, knowing the Republicans, probably not. And, of course, if a woman doesn’t report the rape for whatever reason, she cannot access an abortrion.

This is pure and simple misogyny. I am only a recent pro-choice “convert”, but it is bills like this that have contributed to my shift in opinion. It is unbelievable that the GOP thinks they know better when a woman was raped than that woman herself.

And, of course, the entire bill is utterly classist. Women who are able to pay for their own abortions, get them, but people who need Medicaid or even taxpayer-funded private insurance, are denied abortions in virtually any case. Healthcare for everyone, oh well.

Read Full Post »

Abortion as a Matter of Bodily Autonomy

Over at Feministe, Frances Kissling writes an interesting post, entitled When Does Life Begin?. Frances does not attempt to answer this question, even though she appears to feel that life does not begin at conception. Her point, rather, is that it doesn’t matter when life begins: no-one should be forced to give their body to keep another alive.

As a person who has always felt that life begins at conception, simply because there is no other non-arbitrary point at which life could begin, it was this argument that had me shift my position on abortion from pro-life to politically pro-choice (I would still never undergo an abortion myself). It already came up in a discussion I had with my boyfriend several months ago, when I was still questioning my position, but I was unaware of the importance of bodily autonomy at the time. Now that I have read more feminist writing on the subject, and strongly affirmed my support for bodily autonomy in any other case, I should also affirm it in cases of abortion.

This does mean that I still support abortion up to viability only, because babies don’t need to die in order to relieve their mothers of the discomfort of pregnancy once they are viable. I do not believe that abortion should be used to directly control whether a viable child lives or not, because the biological mother has other options than to parent the child by then. I am aware that viability is a controversial issue, too, and I hold the position that every attempt should be made to keep a baby alive, and that means viability is currently at 22-23 weeks in the industrialized world. This issue is very complicated and converoversial though. I maintain that there is a difference between being a direct burden on another person’s body, and being a burden on society. A number of pro-choicers will disagree with me here.

Read Full Post »

Thoughts on Requirements for Legal Sex Change

As Helen G pointed out on Questioning Transphobia, in the United States, sexual reassignment surgery is no longer required for a sex change on one’s passport. The reasoning behind this change of policy is that some trans travelers have been at risk in countries where changing sex is dangerous. People can also get a temporary passport when they are in the process of transitioning.

This has me thinking about the Dutch situation, where there is no difference between sex on travel documents and on any other legal document. In the Netherlands, one’s legal sex can be changed only if one has completed sexual reassignment surgery, unless it would be medically or psychologically necessary not to perform this surgery. Since non-op transgenderism is hardly recognized in the Netherlands, it’s going to be very hard to get to this status, and pre-op trans people are of course left with their assigned sex on legal documents.

When I learned about the lgal requirements for a sex change on one’s official documents in the Netherlands through my health law handbook, another thing I noticed, was that, in the Netherlands, it is required that one be sterilized before applying for a legal sex change. There is no medical or psychological exception to this requirement. The reasoning, according to the handbook, is that it would be harmful to a future child to be born to a post-transition trans person. I fail to understand this logic, and no arguments were given. It’s probably that society has decided that only those we call “female” can birth children, and, for this reason, a child is very likely to be harmed psychologically by the idea of being born out of a male body. However, isn’t the correct reasoning here that they are harmed by the incogruence between their parent’s body and society’s current norms? In that case, one may question which of these is wrong, in fact. I tend to consider society’s norm of body policing as wrong, but, apparently, the majority thinks differently.

Read Full Post »

Of Bodies and Burdens: Abortion vs. Child Euthanasia

Sometimes, it would’ve been easier if I were still radically pro-life, so that I could tell anyone supporting abortion or euthanasia that people have no right to take the life of anotheer person, no matter how dependent that person is on someone else. Yet I recognize a person’s right to bodily autonomy, too, and for this reason, should be pro-choice: no matter how many alternatives to parenting exist, there is no alternative to gestation other than to terminate. Therefore, if pregnancy threatens a woman’s health or wellbeing – even if that threat is motivated by factors related to the unborn child she carries, such as if that child has disabilities -, the only option to relieve that threat or discomfort is to terminate the pregnancy. If you believe in a person’s right to do with their own body as they please, therefore, you must automatically be pro-choice on abortion.

But what if you do not want a child, and that child is born? If not wanting a particular child is a valid reason to abort when the child is still in your womb, isn’t it a valid reason to terminate the child once it is born? In my opinion, no, because, unlike gestation, parenting by a specific person is not a necessity to keep the child alive. A parent can choose to give a born child up for adoption, or, if the child has disabilities, can choose to put them in a care home. Of course, care homes may provide less-than-optimal services to children, and adoption might affect the child’s mental health, but the solution is to improve care and adoptive services.

It is interesting, of course, that infant or child euthanasia is only legal on children with disabilities, whereas abortion is legal on any fetus up till viability. If being a burden on one’s parents were a legitimate reason to kill, and if it didn’t matter whether a child is still in the mother’s body or not, and if alternatives such as adoption aren’t relevant, either, then euthanasia should be legal on any infant. Also, if the fact that the infant cannot make their wishes known and therefore has the parent make these decisions for them, that should go for any infant, too. No baby can tell their parents that they want or don’t want to die, and any baby could grow up to be a pain in the arse of the parents.

So why is it all about disabled children? It’s probably that it is abled people making these decisions. They think that living in a marginalized body somehow makes you less of a valuable human being. Not only do they allow euthanasia of consenting adults only if the adult is disabled enough by someone else’s standards to be worse than death – despite the fact that people with the same disabilities might live happy lives -, and not on non-disabled people who “suffer life”, thereby stripping adults of the right to decide what to do with their own lives. On top of that, it is only abled people who can decide that a certain body type makes you worse than death, even regardless of your own opinion if you’re a child, regardless of whether other children with the same disabilities live happy lives. In fact, infant euthanasia with parental consent goes farther: if a parent is unhappy, that is a reason to kill the child, regardless of whether other parents may be happy to parent a disabled child, or this specific disabled child.

In short, abortion is legal on any infant up to viability, because this is the only way to relieve the pregnatn person of the discomfort or threat of gestating. On the other hand, once born, if your parents view you as a pain in the arse, but only if you also live in a marginalized body, you can be killed with these parents’ consent if they feel unhappy about parenting you, regardless of how easy it is to get rid of you without killing you. And even if abortion is not merely about bodily autonomy, am I still the only one who perceives a double standard here?

Read Full Post »

Fetal Personhood and Viability

The reason I have always considered the fetus a person – a significantly dependent person, but a person nonetheless -, is that I have never been able to find a non-arbitrary point at which the fetus could possibly acquire personhood. If birth is said to be the criterion, preemies acquire personhood at the same developmental stage hat those who could be born at full term, do not yet possess personhood yet. And if some arbitrary ability – such as the ability to think or feel – is used, there is always the risk that some born persons do not meet this criterion. Even the presence of a cerebral cortex at twelve weeks gestation – except when the fetus is anencephalic – becomes arbitrary here.

The criterion used in the Netherlands to guide abortion law, is somewhat complicated. According to the letter of the law, viability is the point at which no abortions can be performed anymore. This makes sense, in that, once a baby/fetus is viable outside the womb, there is no longer a need to kill them to relieve the pregnant person of the discomfort or threat of gestating.

However, where our law becomes complicated, is that it restricts abortion to the first 21 weeks of gestation. That used to be 24 weeks, but it was determined that babies born at 22 weeks, can survive. Now that seems alright, except that babies born at 22 weeks are not viable in the Netherlands. That is, neonatology has decided it will not resuscitate or treat babies born before 25 weeks gestation – and every baby born at this gestational age, will need these. Yet abortion law has decided that babies are viable by 22 weeks. Who is right here: abortion legislators or neonatologists? Some of my readers may know that I’d side with the abortion legislators here, as I am a strong advocate for the treatment of premature infants regardless of gestational age. However, as long as no neonatoligist in the Netherlands is going to treat babies born at 22-24 weeks, the limbo remains.

Read Full Post »

Enabling Informed Choice on Abortion

First, for those who think I am still politically pro-life, this post is written from a pro-choice perspective. That is not because I have made up my mind about abortion – I am still personally against abortion, and am not sure where I stand politically anymore -, but because my frame of reference on this particular issue is mostly pro-choice. Any pro-life readers – or pro-choice readers, for that matter – who can correct me on any factual errors, are welcome to do so.

IrrationalPoint of Modus Dopens has an interesting post up about fetal personhood. Particularly, she focuses on the topic of requiring ultrasounds for first-trimester abortions. The point of these ultrasounds is to show the woman how her fetus appears at that stage of prenatal development. I used to support it in the name of informed consent, but there are two reasons I don’t think I do anymore: the fact that it is the Florida legislature in this case, rather than a doctor with their patient, deciding to take the procedure, and the fact that ultrasounds in the first trimester are transvaginal. That means that neither the woman, nor the doctor, has any way to refuse having a device stuck into the woman’s vagina. In any other circumstances, that would constitute medical sexual assault and an infringement of the woman’s right to informed consent for medical procedures.

In the comments, IP went on to argue against counseling, delays, and parental or spousal notifications. I agree with regard to parental/spousal notification, because there are a number of reasons a person might not be able or willing to tell her family that she is going to get an abortion – for example, if the parent or spouse is being abusive and reproductive coercion is part of the abuse. It also places an unfair burden on the woman to need to prove she was raped or the victim of incest. This is not even about exceptions for abortion in these cases – when you could argue that the life being saved outweighs the burden to the mother -, but about parental/spousal notification.

With regard to counseling and delays, both of which are standard in the Netherlands, I have less of a problem, in fact. Let’s face it, after all: not every woman who undergoes an abortion, has thought about that decision carefully, or has all the information she needs in order to give informed consent for the abortion. I am not hammering on the fetus as person argument here, since one thing I learned from Blog for Choice 2010, is that every pregnant woman probably realizes she will be terminating a (future) life. Neither am I saying women are too lazy or irrational to think before they undergo an abortion. However, there are plenty of situations in which a woman may not be able to make an informed choice. For example, if she was coerced into getting an abortion by her partner, family or doctor, or if she doesn’t know about alternatives such as adoption – in which case the issue of course remains that the pregnancy itself may be a threat and she may want an abortion. If counseling involves countless repetitions of “Did you know what you are about to terminate could develop into a cute, lovely baby?”, I consider it unnecessary and even emotionally hurtful to the woman. If, however, counseling involves information about all options the woman has in dealing with her pregnancy, aimed at empowering her to make her own choice – and note that pro-choice is not limited to the choice to abort -, that should not be a problem I would think.

Read Full Post »

“Please Don’t Get Pregnant.”

Yesterday, I had a discussion with my sister that started out about abortion. She has always identified strongly as pro-abortion, while I used to identify as pro-life (with exceptions to save the health of the mother) and am increasingly shifting towards politically pro-choice. Personally, however, I remain strongly pro-life, so, even though I choose not to have children, abortion would not be an option for me should I ever accidentally become pregnant.

The reason I am becoming increasingly pro-choice is actually at the core of the remainder of this blog post. One of the main things that drove my opinion away from the pro-life movement – apart from radical nonsense coming from anti-abortion extremists -, was the 2010 Blog for Choice campaign, which had “Trust Women” as its motto. Trust women to make their on decisions regarding reproductive health. This, to be clear, does not merely involve the choice to undergo an abortion, but also the choice to take whatever birth control measures one wants, to carry to term or to parent children. Then, if we believe that women should be trusted to make their own choices regarding reproductive health, we must say that all women should be trusted to make these choices, if enabled to do so. This means that a disabled woman should not be assumed not to be able to make her own choices: if she lacks access to the necessary information to make an infomed choice, she should be enabled to access that information. That enabling can only happen if she is trusted to make an informed choice in the first place.

I cannot be certain whether my family did not or does not trust me, but the continuing discussion with my sister made me feel that at least in part, they may not. As I explained that I would not get an abortion and would prefer to look into adoption services if I became pregnant, my sister told me that she’d discussed the matter with our parents and she would be filing for custody if I had a child. “So please don’t get pregnant,” she added, given that she is a student and wouldn’t want to have a child now.

I am not aware of the exact context of the discussion(s) – my sister mentioned the mental hospitalization of a family member with children, who was facing custody problems, in 2007 and my relationship with my boyfriend, that started in 2008. I am also not aware of the exact reason my family felt the need to discuss their steps if I became pregnant. Neither am I aware of what exactly was discussed there, since obviously I wasn’t present. But that is exactly the point: my reproduction was discussed without me being involved, or without me even being aware. Without knowing whether or not I wanted to have children, and without knowing what measures I took or didn’t take to prevent becoming pregnant, my sister decided that she would be taking custody of my hypothetical child. She apparently didn’t even feel the need to inform me as she discussed the matter.

The problem is not that my sister might be taking custody of my hypothetical child. Even though disability, whether it is physical or mental, should never by definition prevent a person from choosing to have children, in my own case, I have decided that I am not fit to be a parent. As I said, I woud never undergo an abortion and would seek out adoption services, and, if my sister felt that she wanted to have my hypothetical child instead of an anonymous adoptive family, that would be fine with me. I, however, make the decision what happens to my body and my hypothetical child, unless that decision would endanger my child, in which case my family can go to court and indeed file for custody without my consent. But the presumption that I do not have the ability to make informed choices, is entirely false.

There were a number of false assumptions behind this discussion, all of which my sister and/or my parents could’ve asked me about when the subject came up, or which my sister could have asked me about yesterday. Rather than assuming I don’t take birth control because I’m pro-life (uh-huh, I never opposed contraception), or that I haven’t thought about what I would do should I ever accidentally become pregnant, isn’t it possible to just ask what I would want to happen if I became pregnant? We have enough time to discuss my and my family’s (and my boyfriend’s!) options, since I am not actually pregnant now. And even if I were pregnant, there would be enough time to discuss our options, too. There is no need to rush decisions or to presume I am unable to make my own choices just because I’m disabled, or institutionalized, or didn’t use to be on birth control (because I wasn’t sexually active, you know!), or because I for whatever reason am at risk of becoming pregnant and/or unfit to be a parent. Heck, whether I am even unfit to be a parent, isn’t up to you to decide – even if I endangered my child, it would be up to the court to decide so -, and you didn’t know we agree on this subject until I told you so. This signifies all the more that there is no reason to make even hypothetical decisions about me without me involved.

Read Full Post »