Author: Anne Orsi

The fact is that women have been trapped. Reproduction is used, consciously or not, as a means to control women, to limit their options and to make them subordinate to men. In many societies a serious approach to reproductive health has to have this perspective in mind. We must seek to liberate women.

Dr. Nafis Sadik
Executive Director, UN Population Fund

I am a woman in the Bible Belt. In my state, Arkansas, the most restrictive abortion law in the country just passed. The governor vetoed it yesterday, but I don’t expect that to stop it from becoming law. As I write this, the Senate has already overridden the veto, and the House is expected to do so. For some crazy reason, our state legislature can override a veto with a simple majority – the same as they passed it to begin with. Arkansas gives only lip service to the separation of powers.

Last week our governor vetoed another extremely restrictive abortion bill, HB 1037, but the legislature overrode the veto in less than twenty-four hours. HB1037 is a more permissive bill than the one at issue today. It prohibited abortion for any reason after 20 weeks of pregnancy except in cases of medical emergencies. However, the term “medical emergency” under this new act “does not include a condition based on a claim or diagnosis that a pregnant woman will engage in conduct which she intends to result in her death or in substantial and irreversible physical impairment of a major bodily function.” That’s right. If she were so psychologically distressed that she attempts suicide because she wants an abortion, allowing her to abort the fetus does not count as a life-saving measure. In making the decision to terminate the pregnancy, the law specifically prohibits considering psychological harm to the pregnant woman. Doctors who perform abortions anyway become felons under this law.

This law makes no exception for severe fetal anomalies, even if the fetus will never be born alive. It does make exceptions for rape and incest. It’s okay to kill “an individual organism of the species homo sapiens from fertilization until live birth” – that’s how the act defines an unborn child – if it was conceived in reprehensible circumstances, because … why? Is that collection of cells “less human” than one conceived intentionally or negligently? This exception makes no sense, except if we accept that there is something morally wrong with forcing a woman to bear such a pregnancy to term.

And who makes the judgment call about when forcing a woman’s body into service is morally reprehensible? Not the woman herself. She is apparently incapable of that.

Reproductive health therefore implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so.

— 1994 International Conference on Population and Development in Cairo

HB1037 stops abortions at 20 weeks except for cases of rape or incest or to preserve the health of the mother. It ignores completely the fact that the first ultrasound is not done until about 20 weeks into the pregnancy. At 20 weeks, doctors often get their first clues that an “individual organism of the species homo sapiens” might not be viable, or might have horrific defects. At 20 weeks, testing of fetal anomalies may just be beginning, because that may be when they are discovered.

I have a pair of young friends. Six months ago they were faced with an awful diagnosis and a horrific choice. The husband wrote a letter that was posted on the Arkansas Blog. He sent it there at my suggestion. He and his wife wanted to get the word out, in as visceral a way as possible, that this 20-week abortion ban was wrong.

The day they told me they were pregnant, love and excitement shone in both their faces. They are in their late 20’s, comfortable in their careers – he’s a pilot in the Air Force and she’s a surgical nurse – and their relationship is strong and committed. They were over the moon with the knowledge that they would soon be parents for the first time.

A few days before hitting that 20-week mark, they went for the ultrasound appointment. This was when they would find out if the baby was a boy or a girl. Whether the nursery would be pink or blue. Whether they should prepare for a son or a daughter. The husband, K, described the appointment:

Within moments we were looking at our baby girl for the first time. Her name was Amelia.

Imagine how we felt when our ultrasound technician stopped smiling. … Even flying in combat over Iraq and Afghanistan, I had never fully understood the meaning of dread. Now I know, dread is what occupies the 15 minutes between an ultrasound and doctor’s return.

After a very long weekend, we were seen by a high risk specialist. Two new words were inked into our vocabulary: “encephalocele” and “holoprosencephaly.” Do not Google these terms; the results will break your heart. Of her numerous problems, these were the most serious. We had previously opted for every diagnostic test to ensure our baby’s health, and were one of the first couples in Arkansas to try a new screening of our baby’s chromosomes in blood taken from the mother. We had gotten a false negative. Amelia would not survive to term.

“Devastated” does not begin to describe their reaction to the news. Both K and his wife, AJ, have talked to me at length about that awful day, and the awful days that followed. Despite what K said in his open letter, I do think it is important to Google terms like “encephalocele” and “holoproencephaly.”

Encephalocele is a neural tube defect. After heart defects, neural tube defects are the most common congenital abnormalities. A common neural tube defect is spina bifida. Many children with spina bifida can survive, though. Those with large encephalocele cannot, because their brains protrude through a skull defect of the skull, usually in the back of the head. The protruding part of the brain is destroyed because of mechanical disruption of the tissue – it is not where it needs to be – and a restriction of blood flow to the protruding area of the tissue. Brain tissue around the defect is also malformed and disrupted. Large occipital encephaloceles are always fatal because of inevitable damage to the brainstem.

The embryonic forebrain fails to develop into two separate hemispheres in holoprosencephaly. Like with encephalocele, holoprosencephaly can be very mild, such as with a cleft lip and palate, or it can be so severe as to result in the facial features being seriously disorganized, the brain fails to develop, and brain function is severely compromised. Severe holoprosencephaly causes cyclopia – the fetus appears to have only one eye, usually where the nose would be in a normal fetus. Instead of a nose, a tubular growth extends from the forehead. Even malformations that are not this severe result in miscarriage or stillbirth. According to the National Human Genome Research Institute, most cases of holoprosencephaly cause malformations so severe that fetuses die before birth.

Amelia’s holoprosencephaly was not the most severe, but it was severe enough that the doctors did not expect her to be born alive. If she did make it out of the womb, she would likely live only hours at most. With a “reasonable degree of medical certainty,” as we say in the legal arenas, Amelia would never see the light of day. Her parents would never hold her, and if they did she would never know it.

My friend AJ, who was pregnant with Amelia, is a surgical nurse. She knew exactly how grim this prognosis was. From K’s letter:

I cannot adequately describe our grief, fear, and anger, or the agony of days spent on hold with insurance companies and hospitals.

The genetic counselors in the high risk pregnancy center were patient and understanding, but the situation was bleak. We could allow the baby to die naturally, but my wife could feel the tiny baby kicking and that constant reminder would be emotionally unbearable.

“Emotionally unbearable.” What an understatement. Pregnant women are emotionally labile anyway, but knowing that instead of decorating a nursery she was waiting for a miscarriage that might not happen for months would emotionally cripple most women. Instead of decorating a nursery, K and AJ would be in a macabre waiting game with nature. But in the meantime, AJ felt the baby kick and turn. She described to me feeling the baby move inside her in the days after the ultrasound, as she and K waited to see the specialist. With every flutter inside her womb, she cried. K could not bear to bring himself to touch AJ’s swelling abdomen, even though they had spent hours feeling Amelia move in the weeks prior. His emotional response exacerbated hers. If this pregnancy continued for another five and a half months, K and AJ would suffer incredible emotional harm. It hurts me to contemplate the potential damage to their marriage – I really love this young couple.

The doctors did not tell them what decision to make, but they knew they had only one reasonable option: terminate the pregnancy. Or, to use the hot-button term in vogue, a second-trimester abortion.

Again, K’s words:

We returned to the specialist center later and sat down in front of the ultrasound for the last time. The doctor placed a needle through my wife’s uterus to the baby’s heart, which stopped immediately. Two weeks later, our stillborn baby was delivered in a quiet delivery room. She weighed eight ounces, much smaller than I expected.

The two weeks between that last ultrasound and the stillbirth were two very long weeks when A knew that Amelia was gone, but still with them. Her belly was still swollen, but the baby no longer fluttered inside her. She didn’t stop crying as she waited for the miscarriage to begin. Neither did K. They still haven’t stopped crying, but not because of their decision to terminate the pregnancy – they know they did the most reasonable and humane thing for themselves and for Amelia. They grieve for the child that they had hoped would be their daughter. But, they haven’t stopped crying in part because of the pariahs they are made out to be for taking the best action available to them, considering the prognosis and the totality of their circumstances.

Many family friends and coworkers have since come forward with their own stories of abortions, miscarriages, and stillbirths. We had never suspected. As one mentor put it to me, I had joined a secret fraternity of parents who had lost a baby.

The Arkansas legislature refreshed K and AJ’s pain beginning in January with its focus on abortion. The wounds from losing the child they had hoped for are still fresh. They do not regret their decision, but they are very angry. Had this pregnancy happened in 2013 instead of 2012, they and their doctors would be criminally penalized for doing what they believed best in a terrible situation.

As K has said, the 20-week cut-off is arbitrary and wrong.

Our first ultrasound happened at nineteen weeks, as is the case within most pregnancies. It is usually the first opportunity for doctors to diagnose serious problems. By the time we were seen by a specialist, we were past twenty weeks. Recently a coworker came to my wife in tears, sharing her story for the first time. Her own ultrasound had revealed her baby’s fatal kidney failure and she faced the same gut-wrenching decision.

The Arkansas legislation establishes criminality at the very moment when parents and their doctors have to face painful reality. The bill is a product of ignorance and insensitivity to the suffering of parents and their unborn children. This legislation demands that grieving mothers carry their baby as long as possible, without exception. It declares that politicians know better than medical experts in every situation, even ours. This is not an argument about unwanted children. It is about the right of parents and their doctors to make educated and moral decisions with all the facts, not with a calendar.

The debate about abortion is personal for us. We wanted our child.

HB1037 ignores the 1992 U.S. Supreme Court case of Planned Parenthood v. Casey which, because of technological innovations since Roe v. Wade was decided in 1972, moved the date of viability from 28 weeks of gestation to a less definite date. It defined viability as the point at which the fetus could be reasonably expected to survive out of the mother’s uterus. The Casey decision was very careful to point out that the decision of whether, when, and how many children to have was a very personal one, and the individual’s interest in such a decision outweighed that of the state before viability.

The Arkansas legislature apparently believes that if it redefines “viability” as something completely different than the stage of life anticipated in Casey and Roe, it gets around the holding in those cases.

At the capitol, the proponents of this bill were all about “saving children.” With complete disregard for the fact that some children can’t be saved and it is more merciful to end suffering, these people would have us believe that women are cavalierly having “recreational abortions.” Yes, that is an actual phrase that was used. Although there may be some out there, I cannot imagine any woman not thinking very hard about whether to terminate her pregnancy, no matter what stage of pregnancy and no matter what her reasons. Abortion is simply not undertaken lightly, no matter what the anti-choice advocates would have us believe.

They would have us believe that irresponsible women love getting knocked up just so they can have medical procedures done between their legs. Ask any woman: we so adore our trips to the gynecologist, because we get to put our feet in stirrups and have someone go digging around down there. For those people, the worth of a woman is measured solely by the reproductive capacity of her body. She does not have a brain to go along with her genitals, and therefore cannot be expected to use it to make ethical decisions.

There was much testimony pertaining to abortion from women who chose to continue their pregnancies despite fetal abnormalities. Those witnesses ignored the fact that they had a choice to begin with. About 70,000 women die every year from unsafe abortions, and many more suffer infections and other consequences.

Much of the violence against women occurs in the context of sexuality and reproduction. The health consequences of violence often occur in the context of reproductive health and seriously contribute to the burden of disease in women and young people.

Dr. Hiroshi Nakajima
Director General of the World Health Organization

I am very skeptical that if their wives were four and a half months pregnant with a fetus diagnosed with severe fatal holoprosencephaly or irreparable encephalocele, each of the legislators – mostly males – who voted for this bill would require her to continue the pregnancy to the point of natural miscarriage or stillbirth, knowing that instead of decorating a nursery they would spend the next five months planning a funeral. I cannot imagine that someone with such controlling demands would soothe and comfort their pregnant wives, wives who would feel every fetal kick as a false promise of a child that would never live. I can easily imagine that they would refuse to touch her belly so they wouldn’t get attached to a child that would never draw a breath – never mind that their pregnant wives have no escape from feeling those fetal movements. And I suspect that they have no appreciation for the psychological trauma suffered by pregnant women in these situations.

We can make the decision to terminate the life support systems for our aged and infirm family members who are already out of the womb, but we can’t make that same decision until they do make it into the world, under these laws. With the passage of these two laws, Arkansas creates an unconscionable double standard that disproportionately affects the young, the poor, and women.

K says,

It is unfair to demand that parents like us come forward with stories of personal loss, now in the state Capitol or later in courthouses. The decision we had to make was painful, personal, and ethical.

After overriding the veto of HB 1037, which would have made AJ’s doctors criminals for terminating her doomed pregnancy, Arkansas’s Tea Party-dominated legislature once again proved that half-baked legislation makes good PR sound bites to a party that eschews freedom and wants to micromanage other people’s lives down to the most personal decisions.  These laws make a mockery of a Republican party that once championed a smaller government and greater personal freedom. And mock them we do, as we quiver in terror for the freedoms they take away from us. The Arkansas legislature ramped up its war on personal choice to legislate morality even more restrictively in SB 134.

This draconian bill, which the legislature passed and the governor vetoed yesterday, defines fetal viability as a “medical condition that begins with a detectible fetal heartbeat.” Never mind that the fetus is neither truly viable at that moment, nor that Roe. v. Wade defined viability as the point at which a fetus, when delivered, can survive naturally outside the womb. At 28 weeks, or seven months, the fetus has nearly a 90% survival rate, even though it often needs artificial support to aid its continued development.  At 24 weeks, the fetus has about a 50% chance of survival outside the uterus, depending on its weight, development, its mother’s health, and the presence of congenital defects. Viability does not begin with a fetal heartbeat, which begins at around 21 days into the pregnancy.

Reproductive rights … rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so,and the right to attain the highest standard of sexual and reproductive health. It also includes their right to make decisions concerning reproduction free of discrimination, coercion and violence…. In the exercise of this right, they should take into account the needs of their living and future children and their responsibilities towards the community. 

– Paragraph 96, Platform for Action, Fourth World Conference on Women, Beijing.

The current version of SB134 was modified from its original form. It is now ever so much more permissive. At first, the bill outlawed abortion as soon as the cells that will become a fetal heart started rhythmically contracting, at about five weeks into the pregnancy, if counted from the last menstruation. Many women don’t even know they are pregnant by this point, especially if they have irregular menstrual cycles.

This bill coerces women to bear children whether or not they want to, whether or not they believe themselves to be financially, physically, and emotionally capable of enduring a pregnancy or rearing a child. It disproportionately affects young and adolescent women, who tend to be in the least powerful position to do something about their situations.

It abuses women, it insults them, and it oppresses them.

The human rights of women include their right to have control over and decide freely and responsibly on matters related to their sexuality, including sexual and reproductive health, free of coercion, discrimination and violence.

– Paragraph 94, Platform for Action, Fourth World Conference on Women, Beijing

Roe v. Wade didn’t start abortion, it stopped women from dying from abortions. Women who don’t want to bring a child into the world will abort their pregnancies, one way or another.

As a woman in Arkansas, my stomach has been in a knot this entire legislative session. The Tea Party, with its proud anti-intellectualism, its hyper-Christianity, and its coercive tactics is in charge of the state capitol, and Arkansas women’s rights are getting flushed down the drain.

The fact that these bills make exceptions in cases of rape and incest tells me that their supporters are not truly focused on the purported rights of human tissue that cannot survive outside the womb. If that was the case, it would not matter how those cells came to start dividing and how that fetal heartbeat came to be. It tells me, instead, that they care more about controlling the behavior of women. Only when the woman is pregnant under circumstances they find to be morally reprehensible will they permit her to make a decision about the number, spacing and timing of her children, or give her the means to control it if her first line of birth control fails.

I’m too old to get pregnant, and definitely too old to be personally affected by this law. There is a bigger issue, though. What these two laws say about my worth as a woman, as a thinking human being, devastates me. Solely because of my gender, I cannot be trusted to make decisions about my health and the health of any unborn child I might carry. Nor can anyone else born without a Y chromosome.

I have never liked living here. So many of the people I encounter seem to be willfully ignorant, racist, homophobic, disdainful of education, suspicious of those who are educated, untraveled, and hyper-religious to the point of denying the reality right in front of their faces. But before this legislative session, I never before have I seriously considered what it would take to move away from here, to go someplace like Vermont or Washington State, to live in a place where not only would I be respected as a thinking human being capable of making ethical decisions for myself, but surrounded by like-minded people for a change.

I’ve thought about leaving my extended family, who I know would not follow me. I have wondered how often I would see my son, who is my only child and still is the light of my life, even though he is a grown man. I have thought about leaving my comfortable home, making new friends in a strange place, and who in this new place would care if I lived or died.

I don’t want to live in a place where the law restricts me or people like me – my sisters in gender, if not in generation – from doing what we honestly think is best for ourselves. I don’t want to live in a place that has no respect for my brain’s ability to make decisions simply because of my chromosomal makeup.

I feel trapped. This is a dystopic nightmare.

The Handmaid’s Tale is not fiction in every society of the world, even today. It will not be fiction for long in America.