12 March 2014

How Easy It Is

I got a nasty phone call today from someone who clearly thinks that fetuses are more important than the women who carry them, and in some of the hate-fueled garbage that she spewed at me, there was this gem:
How easy is it to kill a baby these days?
First of all, a fetus is not a baby. That's pretty typical rhetoric though, and that's not what I want to talk about.

I'm not sure what country she came from, but here in the good ol' US of A, it's not easy to get an abortion. In fact, it's getting harder and harder every year. In the past three years alone (2011-2013), there have been more abortion restrictions enacted than there were in the entire decade before (2001-2010).

In states such as Pennsylvania, a woman has to attend a "counseling" session at least 24 hours before her procedure. This extra step means that the woman has to come back to the office at least three times: first for the counseling session, second for the actual procedure, and third for a follow up visit. In many states (such as Texas), there are very few abortion providers, which means that women have to drive long distances (sometimes hundreds of miles) to get the procedure. The more times they have to come into the clinic, the more the travel expense is, and the harder it is to arrange to get off work or to get other childcare arrangements (most women who get abortions already have one or more children).

Even though multiple states already have mandatory counseling sessions and waiting periods, some states are trying to make those waiting periods longer. In January, Louisiana tried to implement a 30 day waiting period. That's an additional 4 weeks. In some places, women can't even get abortions if they're more than 20 weeks pregnant. The longer the woman is in the pregnancy, the more expensive it will be. And many clinics will not perform abortions after a certain number of weeks.

In addition to the counseling session, many states mandate an ultrasound before the procedure. In some states, the doctor has to show and describe the ultrasound to the woman, as if she doesn't understand that there's a fetus inside her. In some states, and in certain cases, the doctor would even have to do a transvaginal ultrasound for early pregnancies, since the fetus is very small and could be hidden behind the pelvic bone. (A transvaginal ultrasound is exactly what it sounds like: the doctor puts a wand inside the woman's vagina to see the fetus. It's invasive and unnecessary.)

Also in Pennsylvania, young women under 18 need to have parental consent before they can get an abortion. If they cannot or will not get consent from a parent, they have to go through a judge to get a judicial bypass. Even if they go through that process, the judge could still decide that they're too immature to get an abortion (but mature enough to carry, birth, and raise a child).

It's also important to mention that abortions are not cheap. For many people living around or below the poverty level, scraping up a few hundred dollars for an abortion and the related visits is nearly impossible. Most insurance plans will not cover abortions, and neither will any federal funds. The cost alone is sometimes enough to make abortion out of reach for low-income women.

And after a woman jumps through all those hoops and legislative burdens, she has to come to the clinic and face the protesters. Sometimes, the protesters are "peaceful"; they hold nasty signs and pray loudly at you. Many times, it's not that easy. Many protesters yell at patients and their family members: disgusting things about killing "babies" and going to hell. Some are violent and "in your face." A select few go with terrorism: shootings and bombings of abortion doctors and clinics. Even worse, the woman coming into the clinic often knows some of the protesters, especially if she goes to church with them. I've already had patients call to ask if we have a back door they can come in to avoid their fellow church members protesting out front.

And those are just the burdens on the patient. There are also plenty of laws about the actual abortion facilities and doctors that perform them, called TRAP laws (Targeted Regulation of Abortion Providers). Some of these laws force abortion providers to have admitting privileges at a local hospital, which can be difficult when local hospitals are not politically inclined to provide those privileges to abortion providers. Other laws affect the actual facilities where the abortions are performed. These laws force clinics to adhere to Ambulatory Surgical Facilities regulations (ASF), which are burdensome and unnecessary. For example, ASF regulations dictate frivolities such as how wide the hallways must be. Meeting ASF standards can be extremely costly, and they do not ultimately benefit the patients.

So please, don't try to tell me that it's "easy" to get an abortion in this country. Just because it's legal to get an abortion in the US, does not mean that it's easy or even accessible to most women.


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