Love’s Labour Lost: An act of desperation leads to a bad law

There is a saying in the law that “hard cases make bad law”.  This tragic story is one of those hard cases:  Last year in June, a 17 year old girl, seven months pregnant, was told by her boyfriend, the baby’s father, that he would leave her if she didn’t get rid of the unborn child.  So, the girl gives 21 year old Aaron Harrison $150 to beat her up and induce a miscarriage; it didn’t work – the baby survived, was born in August and, fortunately, adopted. The girl pled no contest to a second-degree felony count of criminal solicitation to commit murder, but the charges were later dropped as a judge ruled that under state law, she could not be held criminally liable.  Harrison is serving a sentence for up to 5 years for the “attempted killing of an unborn child.”

Utah’s legislative response:  Pass a bill that charges pregnant women and girls with murder for having miscarriages caused by "intentional or knowing" acts; so that if this happens again, the 17 year mother could face a prison sentence of 15 years to life. (The Text of the Bill can be accessed here.)

But no one is addressing the underlying problem  -- Sure, there is plenty of blame to go around – the pregnant minor, the baby’s father, the guy who agreed to beat her up – But there also lots of questions that need to be asked, such as “How could this have been prevented?”   Did the 17 year old or her boyfriend have sex education?  Did either of them have access to birth control?  Was the 17 year old aware that she had the right to a legal abortion?  Did her parents or the boy’s parents discuss alternatives with her?  Did ANYONE in the community discuss her options or offer her support? – Or did they figure that every seventeen year old was as mature as Ellen Page’s character in Juno and everything would be hunky dory? (They obviously haven’t watched Revolutionary Road)   As Lynn M. Paltrow, the executive director of National Advocates for Pregnant Women, commented, how this happened is being obscured because of the sole focus on the baby; she asks “Why would a young woman get to a point of such desperation that she would invite violence against herself?”

According to the Guttmacher Institute, which advocates for sexual and reproductive health in the United States, 93 percent of all Utah counties have no abortion provider. And I would venture to guess that sex education and access to birth control is fairly limited where this happened. (Somebody, please correct me if I’m wrong)

Planned Parenthood Melissa Bird is concerned that the language of “intentional or knowing” is still problematic, leaving suspicion open to any miscarriage: “What happens to women who are in abusive relationships?" she asks. "What happens if a woman threatens to leave the abuser, falls down the stairs and loses the baby? What if the abuser beats the woman and causes a miscarriage? Could he turn her in? Who would the prosecutor believe? What happens if a drug addict who’s trying to get clean loses her baby? Will she be brought up on murder charges?” (full text accessible here)

If there is anything that approaches a consensus in the US on this topic, it is that is prevention of unwanted pregnancy is much better than abortion.  This law doesn’t consider that OR address the underlying problem – it doesn’t help women have control over their reproductive systems or help the unborn; it penalizes the mother for being desperate.

[Cross-posted on IEET’s blog]

Randi Epstein's "Get Me Out: Making Babies Throughout the Ages"

As I was driving past the Brazilian Embassy a few days back on Massachusetts Ave in DC, I turned on the radio and heard "So tell me about these do-it-yourself forceps". My interest was instantly piqued. It was Fresh Air on NPR, and Terry Gross was interviewing Randi Epstein about her new book called "Get Me Out: Making Babies Through the Ages". Though the interview was only about 15 minutes long, it gave a very exciting example of what the book would provide, a deep look at technology, politics and sociology behind the history of women conceiving and delivering babies, right up until today's discussion of designer babies. Randi's interview was fascinating and I'm looking forward to grabbing the book!

[Editor's note: And read together with our previous post about Why I Love Designer Babies, you get a really  interesting, fun, and thought-provoking read]

Is GARDASIL® a responsible mandate?

If the common goals between the public and the pharmaceutical giant Merck in the controversy over compulsory HPV vaccination were long-term cost containment and public safety by reduction and prevention of widespread disease (HPV and cervical cancer, in this case), and GARDASIL is supposed to achieve both objectives; then, mandatory GARDASIL vaccinations for young women is worth investigating.

Compulsory HPV vaccination for girls before they become sexually active is said to cut long-term costs in their healthcare (especially costs related to cervical cancer). However, these costs may be outweighed by long-term costs that are unknown at this time. According to Merck's website, GARDASIL has only been tested for over a decade, which is not sufficient in considering the long-term effects of a drug on a young woman's reproductive system. Currently, GARDASIL has not been evaluated for the potential to cause carcinogenicity or genotoxicity... it is not known whether GARDASIL can affect reproductive capacity (Merck 2007). Because a little over a decade is arguably insufficient time to recognize all of the implications that the drug may have on a woman of childbearing age who received the vaccine prior to, or during puberty, we do not know the long-term costs of what may result from the use of GARDASIL. And, we cannot assume that GARDASIL is cost efficient. We cannot consider this vaccine to be an effective one in reducing or preventing long-term, perhaps costly health problems.

As the second most common cause of cancer death in women worldwide, resulting in nearly a half-million diagnoses and 240,000 deaths each year (Merck 2007), and because 6 million people in this country become infected with HPV every year, and nearly 10,000 women are diagnosed with cervical cancer (Colgrove 2006), HPV and cervical cancer are undeniably very serious threats to public health. Compulsory HPV vaccination for girls before they become sexually active is said to significantly reduce or even prevent widespread cervical cancer. Because there is some evidence of its success in preventing four types of HPV, two of which are leading causes of cervical cancer, the fact that there are at least short-term benefits to GARDASIL is undeniable. However, the vaccine should be made accessible without mandating its use. From a moral standpoint, it seems that the use of the GARDASIL should be accessible at least for those at high risk (i.e., with family history of cervical cancer, etc.). Without long-term evidence of its efficacy and safety, it seems irresponsible (on the part of government, as well as Merck) to mandate its use, but also to deny its access completely.

The best possibility at this point is to wait until further, more conclusive and long-term research has been conducted. Given more time, competition will likely increase, which will inevitably reduce the cost to the consumer (or government), as well as provide more sound evidence regarding its long-term efficacy and safety.

References:

Merck. 2007. CDC Finalizes Advisory Panel Recommendations for GARDASIL®, Merck Cervical Cancer Vaccine. http://www.merck.com/newsroom/press_releases/product/2007_0322.html (accessed September 25, 2007).

Colgrove, J. 2006. The Ethics and Politics of Compulsory HPV Vaccination. http://www.natap.org/2006/newsUpdates/121106_05.htm (accessed February 20, 2008).

Yes or No to In Vitro?

The Women's Bioethics Project recently had the opportunity to work with web TV hosts and producers Whitney Keyes and Wyatt Bardouille.  They interviewed one of our book club non-fiction authors, Beth Kohl, about her personal experience with assisted reproductive technologies.  With engaging humor and wit, Whitney, Wyatt and Beth explore the reality of the ART process as well as some of the ethical implications.  Sometimes we get lost in the complexity of ethical debates and forget that these issues affect real people with real stories. Narrative matters.

 

You can watch the segment "Yes or No to In Vitro?" here.  

Tooting our own horn . . .

Our friends at RH* Reality Check just posted that they've named this blog--along with several others--"Excellent."

Thanks to RH Reality Check, and congratulations to WBP and to the blog contributors!

....*that's for Reproductive Health

Quote of the Day: Being both pro-life and pro-choice

Anna Clark over at RH Reality Check wins the spot for "Quote of the Day" for the moving essay she has written about how she considers herself both pro-life and pro-choice -- She starts out:

"What if I told you that I used to call myself pro-life?

What if I said that I once believed abortion was murder, or that I suspected women used the procedure to bypass the consequences of sex?

If I told you, would I lose your respect? Would you be suspicious when I say that today I'm committed to the right to reproductive health, access, and choice?"

She then details her ambivalence, her journey and the realization of the complexity of the issue -- the quote that got me, though was this one:

"Pro-choice society, like democractic society, is predicated on space for those who disagree. When we play sides, we forget there are no enemies in the vision we pursue. Our inclusiveness of those who choose not to have abortions, and even those who judge abortion to be morally wrong, is our movement's power. When we approach anti-choicers as friends, not only do we act on the heart of our beliefs, but we create space for anti-choicers to become our allies."

What a poignant reminder -- Life -- it's a beautiful choice.

Not Just a Price Increase: The Human Cost of Contraceptive Prices

After more than a decade of decreasing birth rates among teenagers, the birth rate among teenagers 15 to 19 in the United States rose for the first time since 1991, according to a recent report by the Centers for Disease Control. Births among teenagers tend to lead to poorer health outcomes for both the young mothers and their babies. Not surprisingly, the report further inflamed the already heated debate surrounding “abstinence only” versus “comprehensive” sex education and ignored crucial access issues. Sexually active women, especially young women, are at increasing risk for unintended pregnancy and unmarried pregnancy due to constricted access to effective contraception on a number of fronts. First, the increase in the number of states limiting teens’ access to confidential reproductive health services, legislating parental notification laws not only for abortion but also for contraception despite demonstrated reductions in teen pregnancy rates. Second, women’s and girls’ reproductive health is endangered by pharmacists’ refusals to fill legal prescriptions for emergency contraception and oral contraception, their refusals increasingly protected by so-called “conscience” legislation that sacrifices women’s and girls’ health to ideology. No lobby no presence. Third, the cost of contraception has increased beyond the means of college students. In July the Centers for Medicare and Medicaid issued regulations that remove the incentives for drug companies to provide deeply discounted prices to college health clinics; a one-month supply of oral contraceptives, formerly $3-$5 at college health clinics, now costs between $40 and $50 for name brands and $15 to $20 for generics. The price increase was widely expected to cause students to switch to less reliable forms of birth control (oral contraceptives are used by 39% of women in college according to the American College Health Association) or to cease using birth control due to lack knowledge about alternatives. Some college health clinics have tried to subsidize a portion of the price increases; others have ceased to offer oral contraceptives altogether.

We’ve lost sight of why we are having the sex education debate in the first place: because of its serious implications for women’s and girls’ health and well being. The ideal of access is not exhausted by having the best available information; we also need to assure the material conditions of making that information effective.
RNF

Legal Rights for Embryos?

Attorney and reproductive rights expert Jessica Arons has written a compelling analysis of a bizarre piece of legislation granting individual rights to embryos. According to Arons, "The state of Louisiana has assigned to human embryos a legal identity with rights that can be litigated in court—regardless of whether the embryo is in a Petri dish in a lab or in a womb, so long as rights have attach[ed] to an unborn child. The statutes go on to provide the fertilized ovum with an entitlement to sue or be sued. The implication of this provision is that an embryo should be thought of as a child. But embryos and children are patently not the same and the law should not treat them as such." The article is published in the Center for American Progress’ exciting new science policy journal called Science Progress. You can read the complete article here.

A Little Dab Will Do Ya ...

[cross-posted from GCM News ... sign up for the Global Campaign for Microbicides newsletter at http://global-campaign.org]

A simple technique using nothing more than cotton swabs and vinegar could help prevent the deaths of more than 250,000 women a year. Cervical cancer – a sexually transmitted disease caused by the human papilloma virus (HPV) – is the leading cause of cancer-related mortality in the developing world. Early diagnosis and treatment is key, but current screening and treatment technologies, such as Pap smears and the newly approved HPV vaccine, are too costly to be used widely in resource-poor countries. Fewer than five per cent of women in Africa, Asia and Latin America are screened for cervical cancer, as compared to 70% of women in North America and Europe.

In 1999, researchers in the U.S. and Zimbabwe showed that trained nurse-midwives who wiped a patient's cervix with acetic acid (white vinegar) accurately detected more than three-fourths of pre-cancerous and cancerous lesions; tissue harboring such lesions turned white when exposed to vinegar, and could be easily seen during a visual inspection of the cervix.

In a study recently published in the British medical journal The Lancet, researchers in India and France have built upon that finding to show that this method – visual inspection of the cervix using acetic acid (VIA) – is as effective as Pap smears for detection of cervical cancer and dysplasia. In the study, 49,311 sexually active women in Tamil Nadu were randomized to receive VIA or existing cervical screening and care. Women who were VIA-positive were offered further treatment, including cryotherapy to remove any lesions, or a referral if they had invasive cancer. Women who underwent VIA had a 25 percent reduction in cervical cancer incidence and a 35 percent reduction in deaths compared with the women who received standard screening and care.

As promising as these results are, however, it is important to note that the Lancet study was performed at a clinic with dedicated staff and in an area where treatment for cervical cancer was readily available. The VIA screening method is simple and cheap, but many women in resource-poor countries still lack access to basic medical services, let alone treatment and care for cervical dysplasia or cancer. As always, technologies are only useful if they are not only effective but also available, affordable and acceptable to the people who need them.

The painful irony is that cervical cancer screening is of no use to women who cannot access treatment to prevent the onset of cancer. This breakthrough only underscores the need to advocate relentlessly for adequate access to the full spectrum of reproductive health care options, including (and especially) treatment for life threatening conditions. This is surely a case in which half a loaf really isn’t better than no loaf at all.