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Vidhya Alakeson on US anti-abortion legislation

10 May, 10 | by BMJ Group

For most of last year, a van covered in anti-abortion slogans has been parked on the corner of Independence Avenue and 3rd Street in Washington DC. Directly in front of it was the US Capitol, home of Congress, and across the street was the main building of the Department of Health and Human Services. The reason for the van’s presence: health reform. In much of Europe, abortion is not even an election issue, let alone a healthcare issue. In the US, healthcare reform can easily get tangled up with abortion.

The reason for this is the Hyde amendment, passed in 1976, three years after the Supreme Court decision that made abortion before 22 weeks legal across America. The Hyde amendment states that no federal funds can be used to pay for elective abortions. The concern among pro-life members of Congress about the most recent reforms was that federal subsidies paid to middle and low income individuals to help them buy insurance could be used to purchase health plans that covered elective abortion, thereby indirectly flouting the Hyde amendment. Led by Bart Stupak, a Democratic member of the House of Representatives from Michigan, this pro-life faction was hard to ignore because a significant number were Democrats and their votes were crucial if reform was going to pass in the absence of any Republican support.

In the end, a compromise was struck through an executive order that reinforced the administration’s commitment to the Hyde amendment. Executive orders signed by the President do not have the force of law but act as a mandate on the executive branch of government. In the face of national compromise, several states are pushing a more activist stance against abortion. As with other social issues such as gay rights, it is America’s southern states that are leading the conservative charge.

Oklahoma’s recent law requiring women to see an ultrasound image of their foetus before undergoing an abortion has been widely reported. Other states, such as Kansas, have similar but less severe pre-abortion counselling laws that insist that women are told about the stage of development and probable features of their foetus prior to undergoing an abortion. Last month, the Kansas Governor vetoed an attempt by the state legislature to ban late term providers of abortions from setting up clinics in Kansas. This followed the murder last year of George Tiller, one of the few late term abortion providers in the US. While legislation failed in Kansas, similar legislation passed in Nebraska, making abortion after 20 weeks illegal. In contrast to all previous legislation that limits abortion based on the age at which a foetus becomes viable, the Nebraska legislation restricts abortion based on a claim that foetuses feel pain after twenty weeks.

Other states restrict abortion rights simply by making it almost impossible to access abortion services in state. Mississippi, for example, has only one clinic and it performs abortions only up to 16 weeks. Missouri, a state with close to six million people, has only two clinics, both of which are located in urban centres, out of reach of much of the state’s rural population.

Among all this bad news, there is a silver lining for the majority of Americans who support choice for women. With nominations to the Supreme Court now in the hands of the Obama administration, the threat of overturning the decision in Roe vs. Wade that legalised abortion has receded. Under the Bush administration, this threat seemed very real. The appointment of one more socially conservative Republican justice to the Supreme Court could have been enough to overturn it.

Vidhya Alakeson is a former Harkness Fellow in Healthcare Policy who was based in Washington DC until last month.

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  • Ben

    The reason behind the legislation in states such as Kansas might well be an attempt to dissuade women from having abortions for moral reasons. But, if they do indeed change their mind after being told the full details of the procedure they are asking for (I don’t know if it does make a difference) then surely this is an argument for continuation of this practice. Ethical modern practice includes facilitating informed consent where possible, if women with more information at their disposal make different decisions then surely we should provide that information wherever possible. Not to do so would be to withhold information deliberately so that they are influenced towards the option we agree with. Surely this is more paternalistic and not supporting choice for women?

    I don’t agree with the blanket legislation as not all women will want that much information. Amongst professional circles on the other hand, shouldn’t fully informed consent (given in a considerate and so far as possible values free way) be promoted in this area as much as others?

  • Yonib

    I dont know why Vidhya Alakeson is calling this bad news. Surely it is a good thing to inform the woman what she is exactly planning to do to herself and her baby, rather than realising down the line and regretting her actions, which she cant undo.
    Most women do not get enough information on the state of the fetus before they agree to the abortion. Health care providers are largely to blame for taking on this procedure without giving and getting fully informed consent. What is being done at the moment, is partially informed consent, and this is wrong.
    I wish healthcare legislation makers realise how many lives are being destroyed ( mother and fetus), by this partial withholding of information.
    Y

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