First, from The New York Times, The New Abortion Providers:
[After Roe vs. Wade,] the clinics also truly came to stand alone. In 1973, hospitals made up 80 percent of the country’s abortion facilities. By 1981, however, clinics outnumbered hospitals, and 15 years later, 90 percent of the abortions in the U.S. were performed at clinics. The American Medical Association did not maintain standards of care for the procedure. Hospitals didn’t shelter them in their wings. Being a pro-choice doctor came to mean referring your patients to a clinic rather than doing abortions in your own office.
This was never the feminist plan. “The clinics’ founders didn’t intend them to become virtually the only settings for abortion services in many communities,” says Carole Joffe, a sociologist and author of a history of the era, “Doctors of Conscience,” and a new book, “Dispatches From the Abortion Wars.” When the clinics became the only place in town to have an abortion, they became an easy mark for extremists. As Joffe told me, “The violence was possible because the relationship of medicine to abortion was already tenuous.” The medical profession reinforced the outsider status of the clinics by not speaking out strongly after the first attacks. As abortion moved to the margins of medical practice, it also disappeared from residency programs that produced new doctors. In 1995, the number of OB-GYN residencies offering abortion training fell to a low of 12 percent.
“Under pressure and stigma, more doctors shun abortion,” wrote David Grimes, a leading researcher and abortion provider of 38 years, in a widely cited 1992 medical journal article called “Clinicians Who Provide Abortions: The Thinning Ranks.” In a 1992 survey of OB-GYNs, 59 percent of those age 65 and older said that they performed abortions, compared with 28 percent of those age 50 and younger. The National Abortion Federation started warning about “the graying of the abortion provider.” In the decade after Roe, the number of sites providing abortion across the country almost doubled from about 1,500 to more than 2,900, according to the Guttmacher Institute. But by 2000 the number shrank back to about 1,800 — a decline of 37 percent from 1982.
There’s another side of the story, however — a deliberate and concerted counteroffensive that has gone largely unremarked. Over the last decade, abortion-rights advocates have quietly worked to reverse the marginalization encouraged by activists like Randall Terry. Abortion-rights proponents are fighting back on precisely the same turf that Terry demarcated: the place of abortion within mainstream medicine. This abortion-rights campaign, led by physicians themselves, is trying to recast doctors, changing them from a weak link of abortion to a strong one. Its leaders have built residency programs and fellowships at university hospitals, with the hope that, eventually, more and more doctors will use their training to bring abortion into their practices. The bold idea at the heart of this effort is to integrate abortion so that it’s a seamless part of health care for women — embraced rather than shunned.
Second, from Newsweek.com, The Anti-Lesbian Drug:
Genetic engineers, move over: the latest scheme for creating children to a parent’s specifications requires no DNA tinkering, but merely giving mom a steroid while she’s pregnant, and presto—no chance that her daughters will be lesbians or (worse?) ‘uppity.’
Or so one might guess from the storm brewing over the prenatal use of that steroid, called dexamethasone. In February, bioethicist Alice Dreger of Northwestern University and two colleagues blew the whistle on the controversial practice of giving pregnant women dexamethasone to keep the female fetuses they are carrying from developing ambiguous genitalia. (That can happen to girls who have congenital adrenal hyperplasia (CAH), a genetic disorder in which unusually high prenatal exposure to masculinizing hormones called androgens can cause girls to develop a deep voice, facial hair, and masculine-looking genitalia.) The response Dreger got from physicians and scientists who were outraged over this unapproved use of dexamethasone caused her to dig deeper into the scientific papers of the researcher who has promoted it.
Dreger is one of the women who brought the clitoral surgeries performed by Dr. Dix Poppas to light.
It has long been a tenet of the pro-abortion forces that abortion = healthcare. It would seem that a great many healthcare providers may disagree.
It would seem that a great many healthcare providers may disagree.
Either that or health care providers don’t like death threats any more than anyone else.
I’m not sure how you come to that conclusion, RonF.
Hey Ron, do you call yourself pro-open heart surgery?
I’m really lucky to live in a country where I was able to get my abortion for free on the NHS.
Had I been under 8 weeks gone, I could have just gone to my local hospital for the pills that would bring about a miscarriage.
However, being 9 weeks along, I had to go to a specialist clinic to have the surgery. Apparently I was lucky because that day there were no protesters outside.
So I would say that abortion here sort of straddles a line between being partly mainstream healthcare and partly specialist.
What struck me most about the staff was how kind and understanding they were. Completely non-judgemental.
On the second piece, there is a lot of buzz about the problems of malformed genitalia. Personally, I think that if there was any doubt that my child would not have a properly formed vagina, I would rather be given the drugs to ensure the correct formation than have someone deny me and my child that right on the basis that it was some kind of genetic engineering.
If they can tell it’s going to be a girl but that there may be developmental problems down there, I can see no good reason for not ‘helping’ things to progress in the right direction.
Joanna, two things:
1) I’m not honestly sure whether to let this comment stand or not, since the other two you’ve placed were dishonest shilling for your site. That’s incredibly obnoxious.
2) You seem to have a tenuous grasp even on those issues about which you’ve deigned to actually comment. “A lot of buzz about malformed genitalia?” In what circles? From who? Do you get that the treatment is untested? Your comment is almost totally content free.
Hey Mandolin
Beg Pardon, but the first line of the cows piece said ‘Post what you want; self-linking welcome’. I clearly misunderstood.
I left the link on the second because I thought it might help to explain and evidence my comment. I appreciate now that it was not polite on a first visit and I apologise.
I would hate to be considered as irritating as the spammers who leave obviously spun comments with no content – or relevance – on my own site and I will try to do better.
As far as abortion is concerned, I would like to think that it is an issue on which I do have a very firm grasp. It was a decision that was not taken lightly in any way because I see the issue from both sides. Had you asked me ten years ago, whether I would have undergone such a procedure, the answer would have been an irrevocable ‘no’ because of the human life involved. Having actually been in the situation, I had to make a decision based on the damage to the living of the survival of the unborn.
What I was trying, rather clumsily, to explain in response to your post was the way it works here in the UK where abortion is legal everywhere.
Whilst most towns have their own clinic that will provide contraceptive advice and free IUDs (including insertion), condoms, pills, etc., and you can get the ‘pill’ form of the abortion process at the local hospital if referred by your GP, getting the surgical procedure is far more complicated.
In many cases, this is still only available at specialist facilities nearer to the major cities, rather than being part of a regular local general hospital.
Whether a deliberate thought process went into this decision, I don’t know, but it does mean that these clinics can still be isolated and targeted by protesters of whatever persuasion, serving to reinforce the idea that abortion is not part of mainstream healthcare over here either.
With regard to the malformed genitalia issue, I hold my hands up and admit that, in my haste to comment on the abortion section of the post, I did not notice the ‘Anti-Lesbian’ drug tag for the second nor read the linked articles.
I commented from the heart, giving a mother’s point of view on the content contained in that section of the post.
I am shocked to learn that the treatment seems to have been given to these women without proper controls being in place. But, as with so many things in the press, this issue will be totally upstaged and hijacked by such shrill headlines about lesbians and sexuality.
The emphasis will be distracted from the real problem which is emotional and terrified women taking drugs that could harm both them and their unborn child in the belief that they are helping them.
By buzz, I mean that over here in the UK media, reports concerning problems with hyperspadias and other genital malformation come up on a regular basis. The majority seem to blame the large quantity of hormones in our water affecting foetuses in the womb… with the implication being that this is due to the number of women taking the contraceptive pill.
We have various ‘health’ programmes on TV which have shown how surgery can rectify the physical issues. However, there are very few which have addressed or even referred to any mental and emotional issues regarding the sexuality of the person concerned.
With Best Wishes
Joanna
I…
What?
Hi Elusis
Well how else would you describe a headline that reads ‘The Anti Lesbian drug’? It’s just guaranteed to stir things up and has been chosen deliberately to do so.
With Best Wishes
Joanna
Joanna,
My astonishment is that your comment is extremely offensive to queer people and their allies who do not find the concern about the anti-lesbian sentiment expressed by these doctors to be “upstaging” and “hijacking,” or “shrill.” For that matter, you add to the offense by using the term “shrill,” a favorite term used to bash women who speak out in public.
You’ve already made a number of comments that can be read as offensively anti-trans, so I don’t know why I’m surprised, but I suppose I was under the impression that there was at least a slightly clearer consensus that “lesbian” is not a bad thing for girls to wind up being.
Hi Elusis
I dont know why you would construe my comments as offensive to queer people since I have never mentioned my own feelings on anybody’s sexuality. I don’t believe it has any relevance to the discussion which I thought was about preventing vulnerable women from being abused by over-enthusiastic scientists. However, I apologise yet again if I have offended anyone with ill-chosen words that are not up to speed on what is considered polite usage.
I am certainly not anti-anything or anyone when it comes to sexuality or indeed sex. And I would not dream of suggesting that it was bad for girls or boys to ‘wind up’ as lesbians, queers or whatever terminology you care to put on it. I hesitate over which word even to use for fear of causing further offence and as I write this I realise that I could be being offensive again for sounding as if I don’t care. It’s just that language seems to be something of a minefield when it comes to sexuality and offence can be taken where none was ever intended. Over here, we tend to refer to people by their names rather than by a sexual label.
It has to be said that the use of the term ‘shrill’ as some kind of ‘bashing’ adjective has not made it to my part of the world but that was the first word that sprang to mind when I read that headline… although not because it was meant to suggest anything about the sexuality of the writer.
Shrill headlines are those which are designed to wind people up and get them arguing emotionally rather than discussing factually. The newspapers and copywriters are adept in this area.
Perhaps you are looking for some kind of argument where there is none.
With Best Wishes
Joanna
I just spent over an hour writing a detailed response to Joanna that got eaten by the spam filter.
I’m sorry, I haven’t the spoons to re-construct it. Perhaps someone else can offer the sort of gentle, introductory walkthrough of “being called out” and “intersex 101” and “GLBT 101” with evidence of usage of both “GLBTQ” and the word “shrill” in the UK and a clear deconstruction of why it’s offensive to talk about “malformed genatalia” and how discussion of anti-lesbianism research is not “hijacking or upstaging” something more important, but I’m now spent.
Here’s the one link I can provide you at this point, Joanna. It’s relevant to our recent exchange. Sorry I’m too tired to walk you through how, at this point.
https://www.amptoons.com/blog/archives/2005/12/02/how-not-to-be-insane-when-accused-of-racism/
It totally sucks that that happened. It must have been some sort of software bug (either in your browser, or in WordPress) — but unfortunately, it’s not in the spam filter, I just looked. :-(
Joanna – fyi hormones in water supplies are not caused by contraception use but by industrial waste.
Thanks for looking, Amp. I don’t know why the filter sometimes decides to flag every post I make. This one would have had a lot of links, but solving the captcha nearly always gets stuff posted in any case.
Whee, technology. I used to habitually select all/copy every so often when writing long posts on Usenet, but I’ve fallen out of the habit.
But, Elusis, do you not see that continually taking offence over perceived insults only serves to alienate people who do not regularly engage in philosophical debate at such high levels?
Please take this next sentence in the spirit with which it was intended but you seem to be getting so caught up in the language used that we end up at cross purposes. The semantics are less important than the overall content.
I repeat what I said earlier, like a lot of obviously less enlightened individuals, I call people by their names without reference to their sexual orientation – it is none of my business and has no bearing on my view of their opinion.
As to malformed genitals – how else would you describe a penis that precludes the owner from peeing because the urethra is in the wrong place? There is absolutely no offence intended.
If you look at what has happened here, the discussion is no longer about the safety of the pregnant women and their babies who are being given possibly dangerous medication, but some vague threat to a sexual preference – which may well have been a quote taken out of context in the first place…
In terms of whether the medical establishment will review the study, which alternative do you think is the one that is most likely to elicit some action?
Wiping my nose and moving on…
The phrase “malformed genitals” is frequently used to refer to clitorises and penises that are perfectly functional but which are considered too large or too small, or other varieties of functional genitals which don’t pass aesthetic tests. The belief that these genitals are “malformed” and need correction leads to atrocities like non-consensual surgery on intersexed infants. These surgeries are unnecessary (since they are about correcting aesthetics), can impair or eliminate sexual pleasure and sexual function, and can cause the infant to be in pain from the surgery for the rest of their lives (or even just in acute genital pain for years of their childhoods). Surgeries done on “malformed” genitals to make them look more iconically female or male also basically involve the assignment of a random sex to the child, and this random assigned sex may well conflict with the child’s sex identification, leading to later years of distress and further need for surgeries, this time with fewer safe and functional tissues.
The surgeries are brutal, non-consensual, unnecessary and dangerous. Many intersex people are on record against them (one such article), arguing that people should be allowed to choose what they want done to their genitals–whether it’s the surgery their parents would have chosen when they were infants, or a different surgery, or no surgery at all–when they are adults and can accurately assess the risks and weigh them against their desires.
Functional problems can be resolved, but to assume that’s the only thing at stake in the term “malformed” genitals is incorrect.
Again, are we not guilty of getting into difficulty over words. Who is it that decides what is too big or too small? Who assigns that word ‘malformed’ based on size?
What is the correct medical term for genitals that do not work properly because they are not formed correctly? Perhaps we should be using that word rather than ascribing it to body parts which society has deemed not the norm?
In an age where body dysmorphia is becoming more and more prevalent because we get to see the genitalia of men and women who have been chosen for an appearance that is aesthetically pleasing to the eye – or to the ego – and even those who have been engineered to fit such a criteria, who is to say what is truly the norm any more? With young girls demanding labioplasties because they think their inner lips hang down to low, it is a truly frightening world.
However, as a parent, just as my natural instinct is to want my child to have two arms, two legs, two ears, etc., so would I want him/her to have genitals that are specific to the genetic coding of the rest of the body/mind. Naturally, I would still love and cherish my child if that were not the case but, given the choice, that’s what every parent would hope for at the beginning of a pregnancy.
On the subject of intersex children, it is horrible what has happened to them as a result of uninformed and ill-advised decisions about surgery but, as a parent, I cannot blame other parents in the past for making such a decision which turned out to have such awful results for the children concerned. The overwhelming desire is to protect your child and, without all the relevant information, making them conform physically to an accepted stereotype to avoid bullies would seem like the best option.
It is easy to be wise with hindsight but I believe that those parents would have agreed to surgery on the advice of the medical professionals with the sole purpose of trying to help their child.
Perhaps, the re-education of the population as a whole needs to be addressed so that such an occurrence is deemed no different from having red hair or six fingers on each hand but I can’t help thinking, with today’s prejudices, that it’s going to be some time coming.
I’m sure it isn’t very politically correct to say it but, if there was a drug that prevented the occurrence of such a condition in future generations, then surely most parents would think it worth further investigation under very controlled guidelines.
PS Thene, thank you for the info. I was aware of it but, recently, heard the plastic packaging theory poo-poohed by some expert or other.
” Who is it that decides what is too big or too small? Who assigns that word ‘malformed’ based on size?”
There are actual definitions for these things used in medical practice. They are arbitrary, in that they have no particular connection to function, but it means that the terms have specific medical implications.
If you don’t understand why you should try to be precise about the words you pick, then I suggest that you should give up writing. Meaning is conveyed through words, you know.
Try reading some more and commenting less. Then maybe you’ll learn how to express yourself better rather than just putting yourself in situations where you end up being imprecise and misunderstood.
Let me put this another way.
You are attempting to invalidate anyone’s response to you by saying that we’re only picking on your words.
Well, your words are all we have. We can’t read your body language. We don’t know you. We aren’t telepathic so we can’t reach through the internet and figure out what you meant.
It’s not like we know you really don’t mean what you said, but you really meant this other thing that you didn’t say. All we know is what you actually said.
So stop trying to shame people for not understanding you (seriously, as a moderator, I am telling you to knock it off), and start trying something else. As to what that something else should be, it’s up to you, but here are some suggestions. A) choose your words more precisely, B) read more and comment less so that you can figure out what words to use more precisely, and/or C) when you realize that what you’re saying isn’t coming out the way you intended, apologize and clarify rather than trying to blame the other person.
The problem with the lack of clarity in your comments is your problem as a writer. It is not our problem as readers.
A couple of points about the dexamethasone in CAH protocol:
1. It is started before any testing can be done which might demonstrate the presence or absence of CAH. So a lot of embryos and their mothers are being unnecessarily exposed to a drug which can have fairly nasty side effects, especially when used long term.
2. The genital malformation in CAH is NOT the worst problem it causes. At least not always. Some forms of CAH have only sex hormone problems and they’re otherwise ok. Others are associated with mineralcorticoid deficiency which is life threatening if not treated. Baby girls born with CAH are usually quickly tested to ensure that they do not have mineralcorticoid deficiency and typically have few problems. Baby boys, lacking the obvious physical finding, tend to get diagnosed much later and only after other problems ranging from infectious diarrhea to Munchausens have been ruled out. They are at much higher risk and suffer more in their first few months of life due to the lack of physical signs that could lead to a rapid diagnosis.
Now, consider a baby girl treated in utero with dex. She has perfectly normal genitalia but still has a mineralcorticoid deficiency. But because of her normal genitalia even if the pediatricians consider CAH they will likely dismiss the idea because of her normal genitalia. In principle, the parents and the obstetricians will know what occurred and will make sure that newborn girls are tested. But people move, change doctors, forget what they were told (especially at a stressful time like after the birth of a baby). At some point, some kid’s going to get into real trouble that way.
Is it worth it to correct an abnormality which is really nothing more than being outside the 95% confidence interval cosmetically? I’ve been using the term malformation to describe the changes in CAH but really the “malformation” is usually nothing more than a slightly larger than average clitoris. This is a problem…how? Compared to the risks of the medication and risk of missed diagnosis of other problems, I really don’t see it as a good solution.