Happy New Year, all. Took me 5 days to get angry about something; a new record for me! Well, more annoyed than anything else. Who can really afford to get angry about all the stupid crap we see in the media? Us WoC gotta watch that blood pressure, after all.
This article in the NYT is what’s annoying me. It starts off innocently enough with a classic “duh” moment, noting that many women take dangerous risks to end their pregnancies sans medical attention or prescribed drugs. It guarantees a surge in such homemade abortions by pretty much telling the readers what drugs to ask for and how to ask for them, then how to administer them (which sounds seriously problematic to me, but fine, they’re the Times, they can afford lawyers if someone tries it, dies, and the family sues them). It goes further into “no shit, Sherlock” territory by noting the reasons women might do this: cost, shame, a desire for privacy, distrust of hospitals, yatta yatta yatta.
Very quickly, though, it becomes clear that the article is specifically focusing on a certain subset of women: primarily Dominican women in the Washington Heights area. OK, makes sense; that’s who made up the primary focus of a study by Planned Parenthood cited in the article. But see if you can spot the point in the passage below where I started to get annoyed.
One study surveyed 1,200 women, mostly Latinas, in New York, Boston and San Francisco and is expected to be released in the spring; the other, by Planned Parenthood, involved a series of focus groups with 32 Dominican women in New York and Santo Domingo. Together, they found reports of women mixing malted beverages with aspirin, salt or nutmeg; throwing themselves down stairs or having people punch them in the stomach; and drinking teas of avocado leaf, pine wood, oak bark and mamon fruit peel.
Interviews with several community leaders and individual women in Washington Heights echoed the findings, and revealed even more unconventional methods like “juice de jeans,” a noxious brew made by boiling denim hems.
OK, look. Let’s just get this out in the open. Women have been aborting unwanted babies since the dawn of human intelligence. It probably didn’t take much for homo erectus women to cotton to the fact that “scarce food + 10 other mouths to feed + coming baby = bad idea”, or “trek across continental land bridge + coming baby = bad idea”, or any of the other dozens of equations that might cause them to conclude that a pregnancy should be terminated. That’s the unfortunate consequence of our species not having a nice convenient breeding season; sometimes it’s a bad time, or flat-out dangerous, to breed. As a result of this, every culture has its methods of helping women figure out a solution to this problem. Some of them are cockamamie; I have never understood why any woman would think a coat hanger was the way to go, but those certainly happened, and killed their share of women. When I was a student at my predominantly-white, middle-class, “good” high school, the rumor mill had it you could induce an abortion by douching with Coca-Cola. (I guess the rampant yeast infection that would result might kill everything down there, was the idea.) This is not something unique to any one culture.
And indeed, the people who ran the study seem to get this:
“Some women prefer to have a more private experience with their abortion, which is certainly understandable,” said Dr. Daniel Grossman, an obstetrician with Ibis Reproductive Health in San Francisco, which joined Gynuity Health Projects in New York in conducting the larger study. “The things they mention are, ‘It is easier.’ It was recommended to them by a friend or a family member.”
Dr. Carolyn Westhoff, an obstetrician at NewYork-Presbyterian/Columbia University Medical Center, said the trend fits into a larger context of Dominicans seeking home remedies rather than the care of doctors or hospitals, partly because of a lack of insurance but mostly because of a lack of trust in the health care system. “This is not just a culture of self-inducted abortion,” she said. “This is a culture of going to the pharmacy and getting the medicine you need.”
Emphasis mine. This doctor seems to be emphasizing that self-sufficiency, not a some sort of Latin obsession with terminating pregnacy, is the cultural trait that’s important here. Good solid American value, that, right? (Well, wait. Is there any culture that doesn’t value self-sufficiency in one way or another?) And the studies make other important notes: namely that cost, convenience, privacy, and a do-it-yourselfer paradigm are things which might induce any woman, of any culture, to try home abortion. But here’s where things start to get annoying:
It is impossible to know how many women in New York or nationwide try to end their pregnancies themselves, but in the vibrant, socially conservative Dominican neighborhoods of Upper Manhattan, the various methods are passed like ancient cultural secrets.
Hmm. Why do I feel like the article’s authors almost said “ancient Chinese secret”?
Yeah. I smell some exotification goin’ on up in here.
The article goes on to cite “machismo”, tradition, and other strange, exotic reasons why these women might resort to doing it themselves. While the doctors and others who conducted the study take pains to point out that this is not some unique cultural phenomenon, the article seems to go out of its way to imply the opposite — that this is some bizarre practice in which only those freaky brown women would engage. It might as well replace the term “home remedy” with “witch doctoring”. The latter would fit the article’s tone better.
The Planned Parenthood study concluded that women in both nations “seemed to see inducing the termination of pregnancy, or abortions, as a part of the reality of their lives,” in a community where, as one interview subject put it, “we are all doctors.” The report noted that in a culture steeped in machismo, birth control is generally seen as the woman’s responsibility.
Remember what I said about that whole dawn of human intelligence thing? Abortion has been a part of every woman’s life, since about then. Whether she chooses it or not, whether she has the choice or not, whether it’s safe or not, the potential is always there as long as she can walk around and do what she wants with her physical person. So why is it worth noting that Latina women in both the D.R. and America see this as reality? And how, exactly, does a “machismo-steeped” culture differ from any other patriarchial culture in seeing birth control as the woman’s responsibility? Until every nation on earth starts issuing its pubescent boys condoms as a universal manhood ritual, this, too, is something all cultures deal with.
There are a lot of issues for which a culture-specific focus is valid. But, um, last I checked? Every culture has women, however well or poorly it treats them. Therefore every culture has its “home remedies”, its abortifacient folklore, its stupid abortifacients, its traditions. If home aborting was something new, or unique to any one group, the culture-specific focus would be valid, but this is obviously not true. This article’s unnecessary obsession with cultural specifics suggests to me that the New York Times is not actually interested in noting the reasons why women, period, might choose to home abort, period. Instead this article presents yet another chance for the dominant culture to waggle its finger at a strange, scary, “primitive lesser culture” and reassure itself of its own superiority. c.f. Western women griping about “misogynistic” Muslim culture even as they carve and starve their own bodies in accordance with Western men’s wishes; history books which howl about footbinding and neck elongation but never whalebone corsets; and so on.
So often WoC are held up not as people in and of themselves, but as symbols of their culture’s backwardness and need for “guidance,” i.e. domination. It doesn’t make me angry very often anymore, because it happens so damn much I’d blow a gasket if I did. But I’m tired of it. I really am.
The report noted that in a culture steeped in machismo, birth control is generally seen as the woman’s responsibility.
Yeah, that’s totally different than the dominant American culture, in which women are expected to take the pill and men whine about having to wear condoms, and when birth control fails, women are expected to “take care of it” while men aren’t expected to do much of anything.
Jeebus.
What surprised me about having so many women self-inducing abortions without medical supervision — and I’m guessing the genesis of this article — is that it’s happening in New York City, not some Planned-Parenthood-forsaken backwoods. Abortion here is legal, accessible, and the state-funded portion of Medicaid covers it. That’s what makes this population of women worth discussing: what are the factors driving them to self-induce abortions instead of getting either a surgical or RU-486 abortion? Self-inducing isn’t new, it’s old — and that’s exactly why it’s puzzling. Why would anyone living in the alleged “abortion capital of America” still self-induce?
The “machismo” bit made me groan as well, but on the whole I think the article provided some valuable information. The federal government’s twin failures of immigration and health care policy mean that many of these women, despite being poor, aren’t Medicaid-eligible. Even if you are indifferent to these women’s welfare and just look at this in a cost-benefit analysis, it probably costs more to fix the botched abortions in the ER than it would for New York State to guarantee first-term abortions (which are both the cheapest and most politically-acceptable kind) as free for uninsured women, no questions asked about immigration status. I think this is a worthwhile question to pursue in hopes of remedying public policy in this area.
However, then we run into what may be a cultural and not purely cost-based issue: why are the women who could get a medical abortion preferring to self-induce? Some may believe (incorrectly) that their immigration status will be investigated if they go to a doctor. Some may have phobias about clinics and hospitals. If they come from a country where abortion is illegal, they may disbelieve that doctors really will help them, or simply believe that this medical need is not appropriate for a doctor’s intervention. Or the particular shame of abortion is greater in this culture than for other New York women, and therefore our existing methods of obtaining an abortion aren’t working for Dominican women.
Again, if we can sort this out, we can help more women and avert some trips to the ER (or worse, to the cemetery). I don’t think being conscious of how factors particular to a certain population of women might be keeping them from useful medical care is a bad thing, though I certainly wish it were done less clumsily. In my own experience going to a clinic in Harlem for health care, I have heard African Americans, particularly elderly ones, express their distrust of flu immunizations due to this racial community’s history with unnecessary and even harmful medical interventions. If we act as though everyone has the same experience of and responses to medical professionals, we allow many people to live worse and shorter lives than if we reach out to communities that distrust those professionals and take note of their specific concerns.
Hahaha! Good one, NYT. Thanks for the incisive, objective analysis.
Kidding. I’ll thank nojojojo for the incisive analysis.
PG,
If that had been the tack that the article had taken, I wouldn’t have objected. You’re right; there are perfectly valid historical, financial, and legal reasons why women of color, poor women, Jewish women, and other members of oppressed groups would distrust the medical system. But this article didn’t focus on those reasons. They got mentioned in passing by the doctors and Planned Parenthood folks who conducted the study, but the analysis by the article’s authors focused almost exclusively on “cultural factors” like machismo to “explain” the problem.
We have no way of knowing whether the shame of abortion is worse for this group than it is for, say, any other ethnic group that is mostly-Catholic or first-generation American, because the study didn’t compare across ethnicities/nationalities. You’re right in that such a study would be valuable in determining whether Dominican women have more or different issues from other women — but since the cited studies didn’t do that, the article’s authors can’t and shouldn’t conclude anything to that effect. Which apparently didn’t stop them from just making shit up.
We have no way of knowing whether the shame of abortion is worse for this group than it is for, say, any other ethnic group that is mostly-Catholic or first-generation American, because the study didn’t compare across ethnicities/nationalities.
I am guessing that the study got started based on the people who were coming into the ER due to botched abortions. Botched abortions, at least in NYC, are going to catch physicians’ attention because of the whole “why aren’t you getting a medical abortion?” factor. So that’s probably why the Planned Parenthood focus groups were all of Dominican women, and the other study of mostly Latinas.
I can say that abortion is indeed shameful among other first-generation women of color who aren’t Dominican, but the avoidance of medical abortion specifically in favor of the pharmacy or telling friends is what is striking to me. Within my (immigrant and POC) family, abortion is shameful, but it would seem worse to have to tell your friends or people in the neighborhood about it in order to get help. (Especially if it’s a result of premarital sex… the mind boggles at the shame factor there.) Much better to go to the “Americans” — i.e. white people — and have them end the pregnancy before anyone whose opinion you actually care about finds out.
So the avoidance of medical abortion isn’t true of all first-generation women of color in the U.S. even if the shame factor is there. Serious poverty and illegal status, however, would be factors that weren’t as big in my family. One family member briefly considered aborting her first — and what turned out to be her only — child because she and her husband didn’t think they could afford a baby at that time, but at least other relatives could help them out. Those are concerns that are mentioned in the article.
A distinguishing factor not mentioned in the article but that may be significant is that abortion is 100% illegal in the Dominican Republic. Abortion is legal in my family’s nation of origin (although due to poverty and lack of access to medical facilities, many women still die from self-induced abortions). Unfortunately, the article doesn’t even mention this fact, which may be a reason why Dominican women and other first-generation immigrants from nations with abortion bans don’t feel comfortable going to the medical profession. I can imagine that for them, abortion always has been a secret among the women, with perhaps some collusion from the pharmacist, but nothing that could be acknowledged for fear of prosecution.
I am guessing that the study got started based on the people who were coming into the ER due to botched abortions. Botched abortions, at least in NYC, are going to catch physicians’ attention because of the whole “why aren’t you getting a medical abortion?” factor. So that’s probably why the Planned Parenthood focus groups were all of Dominican women, and the other study of mostly Latinas.
Somehow I doubt that. I can’t imagine that Dominican/Latina women are the only ones or even the majority of those who try this self-medicated home-aborting thing. Black women, immigrant women from other races, teen girls regardless of race, and poor white women all have similar knowledge and similar incentive, aside from the “cultural factors” (remember, the doctors also cited cost, distrust of doctors, fear of being shamed at clinics by anti-abortion activists, etc., all things that have nothing to do with machismo). I know that black women, in particular those from African or Caribbean countries, have the same “do-it-yourselfer” attitude and tendency to resort to herbalism/community lore rather than trusting white people. (I should point out here that many Dominicans have the same African roots, but for historical/colonial reasons most do not like being grouped with black Caribbeans. Yet culturally, they’re very similar.) Many African countries make abortion illegal too, and even where it wasn’t, communities still tended to rely on local lore rather than trek long distances to a doctor/hospital. So why weren’t they included? Ditto poor black women from the US, who have a different incentive; these days welfare benefits aren’t enough to cover living expenses (especially in New York). They’ve been shamed as “welfare queens” for decades now, and their group has been medically experimented-on and abused as much as Latinas. I can’t speak for Asian or Native women, not being a part of those communities, but I imagine there’s some “cultural factors” there, too.
It’s good to know the factors relevant to Dominican women, but I just don’t believe this is a problem unique to, or even predominated by, one ethnic group. Which is what the limitedness of this study is (perhaps inaccurately) implying.
My suspicion is that the study was limited to this group for the usual reasons: cost, maybe that’s who the grant was meant to cover, to homogenize the sample, and maybe because Latina women have been under-studied relative to black women. If the lattermost factor is the case, then hopefully they’ll be studying some other under-studied groups too.
Anyone who is Medicaid-eligible doesn’t have cost as a factor if she lives in New York, because our Medicaid program covers abortion (due to the Hyde Amendment, this has to come wholly out of the state-funded portion of the program, using no federal dollars). This would eliminate most poor women who are native-born, immigrated pre-1996, or have been in country legally for five years, from avoiding medical abortion due to its costs. Welfare benefits in the sense of cash subsidies won’t be enough to cover an abortion, but since anyone who is eligible for the cash would be Medicaid-eligible (and indeed a great many more people are Medicaid-eligible than cash-eligible), that’s not an issue.
I suppose the only way to figure out if a disparate number of Dominican/ Latina women are self-inducing, at least in a medically dangerous way, is to collect data from hospital emergency rooms. (Admittedly this will miss women for whom distrust of doctors is so huge that they won’t go to an ER even in extremity, but I have no idea how to capture that population.) Although given South Carolina’s and probably others states’ willingness to prosecute women for late-term self-inducing, I don’t know if hospitals actually record “this seems to have been due to a botched abortion” or if one would have to read between the lines of how the patient presented.