Abortions in the military: disempowering women in service

Prior to Roe v. Wade, women in the military were pressured to get abortions so as to preserve them and their physical availability for service, otherwise automatic discharge from service would result. Now, it's nearly impossible for military women to safely get an abortion, in both the physical and political means. Meet Amy: a Marine who had received excellent performance evaluations and was on track to promotion but now fears for her career's integrity because of her pregnancy resulting from rape while in service in Iraq. A ban set in place in 1979 prevented any federal monies, which includes military medical health plans, from funding abortions. The inability for military physicians to provide abortions forces women who become pregnant in the military to take drastic measures to find an abortion; including local off-base hospitals in the region of service where language/cultural/technical differences in medical practices can jeopardize safety and comfort to the patient, horrifyingly unsafe do-it-yourself methods with any variety of herbal abortifacients or coathanger devices, or taking a stigmatized military leave to travel thousands of miles back home to (hopefully) receive a safe abortion with the proper care in a timely fashion. To make matters worse, the punishment for violating Article 92 of the Uniform Code of Military Justice, ie. having sex in a war zone, can land you a hefty fine and suspended rank reduction. This offense is clearly unjust because a female can't exactly hide pregnancy, whereas the impregnating male can remain elusive under this law, pending genetic paternal tests. Regardless, Amy was afraid to tell her officers, peers and medical caretakers of her pregnancy because she feared being viewed as a "weak female" and most certainly did not want to interrupt her active service in Iraq. After a mess of revelations to her ranking officers, Amy was sent home, mostly on the deabilitating diagnoses of PSTD, depression and anxiety, and oh...to get an abortion after having unsuccessfully attempting to terminate it herself via a few horrifying methods.

Many leaders in government like Rep. Susan Davis (D-CA), Vicki Saporta, President of the National Abortion Federation, and Lieutenant General Claudia J. Kennedy, are pushing hard for abortion rights in the military, but even amongst their battles with abortion legislation, military abortion rights see a small piece of the pie. The barriers facing women in the military to receive abortion services loom at every turn when looking for help. The most straightforward way to put it, is that “servicewomen do not receive the protection of the Constitution they defend" and this is a form of exploitation that is morally unacceptable. 

Octuplets Mother Speaks Out

Nadya Suleman, mother of the recent octuplets born in California, has done her first interview with a major news outlet. (Although Suleman was seeking USD 2 million for the interview, NBC maintains that they did not pay her. However, that doesn't rule out "compensation" in other forms.)

Unfortunately, Suleman's interview has continued to raise, rather than answer, questions. Foremost among them, for me, is her claim that she had six embryos implants per IVF procedure. This... simply does not ring true. Or at least plausible, if she was using a US fertility expert.

Consider this: in order to have done so, this means Suleman would have needed to find, at age 26, a fertility doctor who would implant six embryos. ASRM guidelines are no more than 3 embryos for a woman under the age of 35, and that's if she has a history of problems with conception. With a 'clean' history, only 2 embryos are recommended. Now, it sounds like Suleman might have qualified as having difficulty conceiving, with several ectopic pregnancies and miscarriages prior to IVF. But even accounting for that, it's double the recommended standard. For each pregnancy.

But stop to do the math. While one vial of donor sperm would be more than enough for all of this, it means that they collected at least 36 eggs from Suleman, and that all of those eggs were viable enough to implant once fertilized. Realistically, not every egg retrieved is going to be mature, and not every egg is going to fertilize (unless you're using something like ICSI). Realistically, you're looking, at the very least, at 1/3rd more eggs than that being pulled out (and even that is a very, very low number - remember, they're saying that there were six viable eggs to implant per cycle. A quick web search shows that 1/3 of the eggs removed at any time are not mature, and of the ones that are mature, only half reach the point of being "good enough" to implant).

Now let's go over to CDC stats. While the last data is from 2005, which was going on 5 years ago, Suleman started her IVF course in 2001, so some of this data is specifically applicable (and some of it only extrapolation). According to the CDC, only 35% of ART cycles resulted in a pregnancy, and of those, 82% resulted in a live birth. So again, Suleman seems to have defied the odds. A lot. And as the CDC says about frozen eggs, "[b]ecause some embryos do not survive the thawing process, the percentage of thawed embryos that resulted in live births is usually lower than the percentage of transfers resulting in live births." While only 15% of embryos transferred were frozen, of those 15%, only slightly more than 1/4 ended up in live births.

Again, the odds make this seem incredibly unlikely.

Finally, fertility clinics are required by law to report their ART data, under the Fertility Clinic Success Rate and Certification Act. This gives us a decent way of tracking ART results - and also who is doing ART. In 2005, eleven clinics in California did not report their ART data (which would include embryo transfers/live birth data/etc). Of those eleven places, it looks like seven were within an hour of her home (keeping in mind her back injury likely limited the distance she could travel). Of the clinics that did report their data, 35 are within an hour of Whittier, California. However, given these clinics are compliant with reporting their data, it seems safe to eliminate them from immediate suspicion. (As for the potential Mexcio connection, Tijuana is approximately two hours away. Certainly not out of the question; an hour was a random number drawn from thin air. Suleman has certainly shown herself to be willing to go to significant length, and pain, to achieve her goals.)

All in all, what does this mean? Not much. Over 300 pages of records on Suleman have been released to the press, under a public records request to California's Division of Workers' Compensation. While it doesn't appear that the fertility clinic (or doctor) that treated her is in those records, there is ample evidence to support that she did have problems conceiving, and that she had known psychiatric issues, including what was diagnosed as either postpartum depression or PTSD. Issues that should have limited, if not prevented, future implantations.

Ultimately, until Suleman names her doctor, or said doctor speaks out, little will be conclusively known. But the facts remain simple: the facts do not add up.
-Kelly Hills

Reproductive Autonomy Runs Amok

In a follow-up post to Kelly's previous post, it seems that Nadya Suleman's use of IVF technology is clear misuse and abuse of ARTs (Assisted Reproductive Technologies). The doctor who implanted the embryos should be investigated, because in helping this woman become pregnant with 8 children, he or she violated one of the basic tenets of medicine -- "Do No Harm". Hopefully, the Board of Medical Licensure will investigate and determine what the possible motivation was for this doctor's actions, whether it was a one time lapse in judgment due to extreme personal difficulties, or if it represents a small part of a larger pattern of unethical behavior and practice for the doctor and the fertility clinic.

There are multiple ethical considerations at play when an IVF specialist is approached by any woman and a 'burden vs benefit' analysis is employed. When someone who has already had six children through the procedure seeks more, I cannot imagine a valid or justifiable benefit -- the burdens include physical and financial costs to the mother (who has already declared bankruptcy), to the grandmother, to the siblings, to the children born, and to society. And while one might argue that this is an exercise in reproductive autonomy, we, as a society need to ask 'how far does reproductive autonomy go?' Does it include the right to create children who been disabled or dis-enhanced? (A nightmare scenario vaguely reminiscent of Dean Koontz' novel, One Door Away from Heaven). How we answer this question will have an impact on how we deal with future cases, such as those involving genetic engineering.

Hopefully, this case will call attention to the need for regulation and oversight of Assisted Reproductive Technologies. Currently, we have a laissez-faire attitude towards ARTs and fertility clinics; we have trusted the doctors and clinics to regulate themselves, via the American Society for Reproductive Medicine --and this case demonstrates that we can no longer simply turn a blind eye.

How Many is Too Many?

Unless you've been hiding under a rock this last week, you're aware of the octuplets born to California single mom Nadya Suleman, and the intense ethical debate surrounding her pregnancy. Even before it was revealed that she has six other children (apparently all from IVF, although details are a bit fuzzy), medical experts were ready to lynch the IVF specialist who implanted that many embryos into Ms. Suleman. And since then, the information that has come out has been more and more dismaying. The problem is, much of the information coming out is still speculation, and few solid facts are known. This makes it difficult to do more than speculate and contribute to the signal to noise ratio, which at the moment is definitely loudly on the side of noise.

So rather than continue to discuss the particulars of Ms. Suleman's case, which will have to be dissected in its own due time, I want to open to forum to a related question that has been repeated in the discussion of her story: how many children is too many children? Not how many implanted embryos is too many embryos, but at what point (if any) do fertility doctors say sorry, no more kids? Should Ms. Suleman have had any embryos implanted at all, given her six other children? Or is the ability to pay for IVF the only thing that should be considered? Should the financial state of the individual or couple be considered? Job? Income? What factors should go into deciding whether to treat for infertility via IVF? And should the "how many is too many" question be posed to adoptions, as well (Angelina Jolie and Brad Pitt clearly coming to mind)?

Or put another way: is the problem with the birth of the octuplets the fact that they were born all at once, and if Ms. Suleman had continued to quietly have eight more children via IVF, no one would have said a thing?

It seems like this single question - if an outside source is utilized to have children, is there a point at which it can be determined that the person has too many children to have more - is fraught with the potential of paternalism and of violating the choice of family construction.

I don't even begin to have an answer to this; I doubt I've even begun to tease out all of the potential questions wrapped in what is an incredibly thorny issue. But let's open it to debate - what do you think?
-Kelly Hills

Life begins at....

In light of the recent defeat of the embryos-are-full-persons amendment in Colorado, this article from New Scientist from a few days ago sheds some interesting light on the spectrum of thought on when life (or more specifically moral and/or legal status) begins:

[Whether the legal rights enjoyed by citizens in the state of Colorado should extend to embryos from the point of fertilisation will be decided by its voters on 4 November. A "yes" decision could pave the way for anti-abortion legislation. But an online poll of people with a range of nationalities and religions shows opinion varies widely on the age-old question of when life begins.

The poll was part of a questionnaire compiled by the IVF clinic Reproductive Biology Associates in Atlanta, Georgia, to see how people might view new reproductive technologies.

The Colorado ballot will ask voters whether they think an embryo becomes a person when the sperm and egg fuse. Of the 643 poll respondents, just 22.7 per cent believe this is when life begins. The most popular answer was "when the fetal heartbeat becomes detectable", garnering 23.5 per cent of answers, while "when the embryo attaches to the womb lining" got 15 per cent.

"It demonstrates that this question doesn't have a right or wrong answer," says Jackie Friedman of Reproductive Biology Associates, which will present the survey results at the annual meeting of the American Society for Reproductive Medicine in San Francisco next week.

Unsurprisingly, among Roman Catholics sperm-egg fusion won. In contrast, Jews, agnostics, atheists, Muslims and IVF recipients gave fetal heartbeat the most votes. In North America, 27 per cent chose sperm-egg fusion, 24 per cent heartbeat detection and 18 per cent womb attachment.]

From issue 2680 of New Scientist magazine, 29 October 2008, page 6

So Little Time, So Much Damage To Do

In a quick and dirty driveby post, it's worth taking note that the current administration has 77 days left to change rules and regulations on the environment, civil liberties and reproductive rights (mind you, not in a progressive way)- and, according to an editorial in the NY Times, they are not wasting any time, intending to leave a series of little "surprises" (a euphemistic word for....well, I'm sure you can fill in the blank) for the next administration.

This will surely keep the watchdog groups busy...

Medical Ethics & Human Rights: Impact on the Doctor-Patient Relationship

Event Announcement

The Appignani Bioethics Center and NGO Health Committee are co-sponsoring a panel discussion on human rights and their impact on doctor-patient relationship.

Date & Place: Wednesday, October.29, 2008, 1:00 PM-3:00 PM, 777 UN PLAZA, 10th Floor, 10th floor - Conference Room, NY 10017

A 15 minutes documentary film will be presented entitled "Children of the Decree" by Romanian filmmaker Florin Lepan. In 2004 the film was selected for screening in NYC by the Margaret Mead Film & Video Festival. This documentary analyzes Romania's quest during Ceausescu's dictatorship to increase their population by over fifty percent in a single decade through imposing a ban on abortion from 1966 till 1989. It was a unique experiment in human reproduction infringing upon women's rights:

Flyer

For more information, click here.

Recent reproductive rights rulings ...

A quick recap of two recent rulings that may be of interest:

Yesterday, a federal appeals court overturned Virginia's ban on late-term abortion, passed in 2003 as the "Partial Birth Infanticide Act". Although the US Supreme Court upheld a federal ban on late-term abortion in 2007 (Gonzales v. Carhart), the Richmond-based US Court of Appeals for the 4th Circuit concluded that the Virginia ban was overly restrictive in comparison. In particular, unlike the federal ban, the Virginia law provided no legal protection for physicians who "accidentally" perform an intact dilation and extraction while performing a second-trimester abortion.

Across the pond, the British Parliament voted to keep an upper limit of 24 weeks for elective abortion, rebuffing critics who sought to lower the limit to 12 weeks. A very small number of infants born after only 24 weeks of gestation survive, but a majority of British MPs felt that the small chance of survival did not justify further restrictions on a woman's right to choose.

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.