1. Obstacles to Abortion and Comprehensive Reproductive Health Care Martin Donohoe, MD, FACP

2. Abortion in the U.S. 30 million women have had abortions since legalization (1973) 30 million women have had abortions since legalization (1973) 3 million unintended pregnancies per year in the U.S. 3 million unintended pregnancies per year in the U.S. 1.3 million abortions in 2000 (↓ from 1.6 million in 1990, ↓27% since 1980) 1.3 million abortions in 2000 (↓ from 1.6 million in 1990, ↓27% since 1980)

3. Abortion in the U.S. 21.3 abortions/1,000 fertile women/year 21.3 abortions/1,000 fertile women/year 250 induced abortions/1,000 recognized pregnancies 250 induced abortions/1,000 recognized pregnancies 37% decline since 1982 37% decline since 1982

4. Abortion in the U.S. 49% of all pregnancies are unintended, including more than 30% within marriage 49% of all pregnancies are unintended, including more than 30% within marriage Patients: Patients: 48% over age 25 48% over age 25 20% married 20% married 56% have children 56% have children 43% Protestant, 27% Catholic 43% Protestant, 27% Catholic

5. Abortion in the U.S. Patients: Patients: 59% white 59% white African-Americans and Hispanics more likely to have abortions than Caucasians, in part due to: African-Americans and Hispanics more likely to have abortions than Caucasians, in part due to: Higher levels of poverty Higher levels of poverty Higher rates of unintended pregnancy Higher rates of unintended pregnancy Greater proportion of conceptions that end in abortion Greater proportion of conceptions that end in abortion

6. Most Important Reason Given for Terminating an Unwanted Pregnancy Inadequate finances - 21% Not ready for responsibility - 21% Woman’s life would be changed too much - 16% Problems with relationship; unmarried - 12% Too young; not mature enough - 11%

7. Most Important Reason Given for Terminating an Unwanted Pregnancy Children are grown; woman has all she wants - 8% Fetus has possible health problem - 3% Woman has health problem- 3% Pregnancy caused by rape, incest - 1% Other - 4% Average number of reasons given 3.7

8. Abortion in the U.S. By age 45, the average female will have had 1.4 unintended pregnancies By age 45, the average female will have had 1.4 unintended pregnancies 43% will have had an induced abortion 43% will have had an induced abortion 58% of women with unintended pregnancies get pregnant while using birth control 58% of women with unintended pregnancies get pregnant while using birth control 1 year contraceptive failure rates: periodic abstinence (21%), OCPs (7%), IUD (1-2%) 1 year contraceptive failure rates: periodic abstinence (21%), OCPs (7%), IUD (1-2%)

9. Historical and Contemporary Methods of Unsafe Abortion Many used for millenia Many used for millenia Examples: Examples: Toxic solutions taken orally or intravaginally – e.g., mercury, acid, detergents, etc. Toxic solutions taken orally or intravaginally – e.g., mercury, acid, detergents, etc. Uterine stimulant drugs Uterine stimulant drugs Foreign bodies placed in the cervix/uterus – e.g., sticks, wires, coat hangers, air blown from pump Foreign bodies placed in the cervix/uterus – e.g., sticks, wires, coat hangers, air blown from pump Direct/indirect trauma Direct/indirect trauma

10. Abortion Worldwide 42 million/year 42 million/year 48 unsafe (97% of these in developing countries) 48 unsafe (97% of these in developing countries) 67,000 to 80,000 annual deaths (up to 8/hour) 67,000 to 80,000 annual deaths (up to 8/hour) 13% of all maternal deaths (585,000/year) 13% of all maternal deaths (585,000/year) 1/4 - 1/2 of maternal deaths in Latin America 1/4 - 1/2 of maternal deaths in Latin America

11. Abortion Worldwide 30 infections/injuries for every one abortion death 30 infections/injuries for every one abortion death 220,000 children orphaned each year by poorly performed abortions 220,000 children orphaned each year by poorly performed abortions Use of mid-level providers can decrease complications and deaths Use of mid-level providers can decrease complications and deaths

12. Common Grounds on Which Abortion is Permitted Worldwide To save woman’s life – 98% To save woman’s life – 98% To preserve physical health – 63% To preserve physical health – 63% To preserve mental health – 62% To preserve mental health – 62% Rape or incest – 43% Rape or incest – 43% Fetal impairment – 39% Fetal impairment – 39% Economic or social reasons – 33% Economic or social reasons – 33% On request – 27% On request – 27%

13. Worldwide, every minute 380 women become pregnant 380 women become pregnant 190 women face unplanned or unwanted pregnancies 190 women face unplanned or unwanted pregnancies 110 women experience pregnancy-related complications 110 women experience pregnancy-related complications 40 women have unsafe abortions 40 women have unsafe abortions 1 woman dies 1 woman dies

14. Barriers to Abortion: Legal Viability Roe vs. Wade (1973): Abortion legalized up to “point of viability” (currently 24 weeks) Roe vs. Wade (1973): Abortion legalized up to “point of viability” (currently 24 weeks) After viability, states can ban abortion except when necessary to protect the woman’s life or health After viability, states can ban abortion except when necessary to protect the woman’s life or health Gestational limits (fetus < 500g or < 20 weeks gestational age) Gestational limits (fetus < 500g or < 20 weeks gestational age)

15. Barriers to Abortion: Cost Cost: approx. $350-$450 (1 st trimester); $750- $1300 (2 nd trimester) Cost: approx. $350-$450 (1 st trimester); $750- $1300 (2 nd trimester) ¾ of patients pay out of pocket ¾ of patients pay out of pocket only 1/3 of patients have private insurance coverage; only 1/3 of private insurance companies cover (after deductible met) only 1/3 of patients have private insurance coverage; only 1/3 of private insurance companies cover (after deductible met) most insured patients reluctant to file due to confidentiality concerns most insured patients reluctant to file due to confidentiality concerns

16. Barriers to Abortion: Coverage Medicaid: Medicaid: Hyde Amendment (1978) prohibits federal Medicaid dollars from being spent on abortion, except to preserve the woman’s life or in cases of rape or incest Hyde Amendment (1978) prohibits federal Medicaid dollars from being spent on abortion, except to preserve the woman’s life or in cases of rape or incest But, 22 states allocate Medicaid funding to cover most abortions But, 22 states allocate Medicaid funding to cover most abortions

17. Barriers to Abortion: Coverage Medicare: Medicare: Hyde Amendment applied to Medicare in 1998 Hyde Amendment applied to Medicare in 1998 Bans federal funding for abortions for disabled women except in cases of life endangerment, rape, or incest Bans federal funding for abortions for disabled women except in cases of life endangerment, rape, or incest No state funding of Medicare to make up the gap No state funding of Medicare to make up the gap

18. Barriers to Abortion: Limits on Availability of Emergency Contraception EC available in 102 countries EC available in 102 countries Available OTC in parts of Canada and in S. Africa, UK, France, other European countries Available OTC in parts of Canada and in S. Africa, UK, France, other European countries Cost: $25-$40 Cost: $25-$40 Less expensive options involving OCPs Less expensive options involving OCPs

19. Barriers to Abortion: Limits on Availability of Emergency Contraception Only seven states allow drug stores to sell over-the-counter emergency contraception Only seven states allow drug stores to sell over-the-counter emergency contraception AK, CA, NM, WA, HI, ME, NH AK, CA, NM, WA, HI, ME, NH NY may be next NY may be next Supported by ACOG, AAFP, AAP Supported by ACOG, AAFP, AAP

20. Barriers to Abortion: Limits on Availability of Emergency Contraception Only five states mandate that emergency contraception be available to rape victims Only five states mandate that emergency contraception be available to rape victims IL, WA, NM, CA, NY IL, WA, NM, CA, NY HI and CA have passed bills allowing pharmacists to directly prescribe emergency contraception HI and CA have passed bills allowing pharmacists to directly prescribe emergency contraception Other states considering Other states considering Military clinics not required to stock EC Military clinics not required to stock EC

21. Barriers to Abortion: Provider Availability 87% of counties have no abortion provider 87% of counties have no abortion provider 30% of metropolitan areas have no provider 30% of metropolitan areas have no provider Situation worst in rural areas Situation worst in rural areas 1800 physicians provide abortion services (↓ from 2400 in 1992) 1800 physicians provide abortion services (↓ from 2400 in 1992) 57% are aged 50 and older 57% are aged 50 and older Family physicians facing denial of coverage, huge malpractice premium increases Family physicians facing denial of coverage, huge malpractice premium increases

22. Barriers to Abortion: Harassment of Patients and Providers 55%-86% of providers harassed 55%-86% of providers harassed 80,000 acts of violence and/or disruption at clinics in U.S. and Canada since 1977: 80,000 acts of violence and/or disruption at clinics in U.S. and Canada since 1977: Including 7 murders, 17 attempted murders, 41 bombings, 166 arsons, 125 assaults, 654 anthrax threats (480 since 9/11/2001) Including 7 murders, 17 attempted murders, 41 bombings, 166 arsons, 125 assaults, 654 anthrax threats (480 since 9/11/2001) Abortioncam.com, Army of God, Nuremberg Files website (closed) Abortioncam.com, Army of God, Nuremberg Files website (closed)

23. Barriers to Abortion: Inflammatory Oratory President Bush, declaring January 20, 2002 (20 th anniversary of Roe v. Wade) “National Sanctity of Life Day,” likens abortion to terrorism: President Bush, declaring January 20, 2002 (20 th anniversary of Roe v. Wade) “National Sanctity of Life Day,” likens abortion to terrorism: “On September 11, we clearly saw that evil exists in this world, and that it does not value life. Now we are engaged in a fight against evil and tyranny to preserve and protect life.”

24. Point-Counterpoint

25. Barriers to Abortion Religious “Right’s” unscientific polemics → Religious “Right’s” unscientific polemics →

27. Barriers to Abortion: Religious Hospitals Religious hospitals Religious hospitals 15% of US hospitals 15% of US hospitals ½ of twenty largest health systems in US are Catholic, as measured by patient revenue ½ of twenty largest health systems in US are Catholic, as measured by patient revenue

28. Barriers to Abortion: Religious Hospitals Religious hospitals Religious hospitals Granted special exemptions by federal government to use religious doctrine to guide patient care yet still retain government funding Granted special exemptions by federal government to use religious doctrine to guide patient care yet still retain government funding e.g., Catholic hospitals prohibit provision of abortion services, as well as contraception, sterilization, and infertility services e.g., Catholic hospitals prohibit provision of abortion services, as well as contraception, sterilization, and infertility services

29. Barriers to Abortion: Religious Hospitals Catholic hospitals deny approval of uterine evacuation while fetal heart tones present, forcing physicians to delay care or transport miscarrying patients to non-Catholic-owned facilities Catholic hospitals deny approval of uterine evacuation while fetal heart tones present, forcing physicians to delay care or transport miscarrying patients to non-Catholic-owned facilities Some physicians violated protocol to avoid compromising patient safety Some physicians violated protocol to avoid compromising patient safety

30. Christian Science Pharmacist Refuses To Fill Any Prescription

31. Barriers to Abortion: Legal Spousal Notification Laws Spousal Notification Laws Parental Consent and Notification Laws for Teen Abortions Parental Consent and Notification Laws for Teen Abortions Mandated waiting periods Mandated waiting periods 24 states 24 states Most have 24 hour waiting period Most have 24 hour waiting period Alabama requires sonogram prior to pregnancy termination Alabama requires sonogram prior to pregnancy termination

32. Parental Consent and Notification Laws for Teen Abortions 21 states require parental consent 21 states require parental consent 13 states require parental notification 13 states require parental notification 1 state requires both 1 state requires both 16 states do not require parental permission 16 states do not require parental permission 2006: CA and OR ballot measures to require parental consent failed 2006: CA and OR ballot measures to require parental consent failed

33. Barriers to Abortion: Biased Counseling Laws More than 20 states More than 20 states Often deceptively labeled “Mandated Informed Consent” or “Women’s Right to Know” Laws Often deceptively labeled “Mandated Informed Consent” or “Women’s Right to Know” Laws Scare tactics re safety of abortion Scare tactics re safety of abortion Women read a lengthy list of possible but very rare complications from abortion (but not list of benefits of abortion) Women read a lengthy list of possible but very rare complications from abortion (but not list of benefits of abortion)

34. ACOG Position Dcotors whose personal beliefs require them to deviate from standard practices such as providing abortion, sterilization, or contraceptives should: Dcotors whose personal beliefs require them to deviate from standard practices such as providing abortion, sterilization, or contraceptives should: Give patients prior notice Give patients prior notice Offer timely referral Offer timely referral Provide medically-indicated services in an emergency Provide medically-indicated services in an emergency Practice close to physicians who will provide legal serivces or ensure that referral processes are in place so that patient access is not impeded Practice close to physicians who will provide legal serivces or ensure that referral processes are in place so that patient access is not impeded

35. Barriers to Abortion: Publicly-Funded “Crisis Pregnancy Centers” 2500-4000 nationwide, some receive state funding 2500-4000 nationwide, some receive state funding Outnumber abortion clinics Outnumber abortion clinics Listed in phone book under “pregnancy services” or “abortion services” Listed in phone book under “pregnancy services” or “abortion services” 48% of college health clinics routinely refer women who might be pregnant to CPCs 48% of college health clinics routinely refer women who might be pregnant to CPCs 81% routinely refer to full-service health clinics 81% routinely refer to full-service health clinics

36. Barriers to Abortion: Publicly-Funded “Crisis Pregnancy Centers” Staff try to dissuade clients from having abortions through misinformation exaggeration of risks, myths, and fetal photos/body scans Staff try to dissuade clients from having abortions through misinformation exaggeration of risks, myths, and fetal photos/body scans Stop Deceptive Advertising for Women’s Services Act died in House Committee Stop Deceptive Advertising for Women’s Services Act died in House Committee

37. Barriers to Abortion: Scare Tactics, Misinformation, and Pseudoscience Scare tactics re safety of abortion, contraception, and STD prevention: Scare tactics re safety of abortion, contraception, and STD prevention: E.g., Cardinal Alfonso Lopez Trujillo (the Vatican’s spokesperson on family affairs): E.g., Cardinal Alfonso Lopez Trujillo (the Vatican’s spokesperson on family affairs): “Relying on condoms is like betting on your own death...They [the WHO] are wrong about that [condoms are a highly efficient means of preventing the spread of HIV]”

38. Facts re Abortion One of the safest and most common medical procedures available One of the safest and most common medical procedures available Risk of death from legal abortion less than that from a shot of penicillin Risk of death from legal abortion less than that from a shot of penicillin 10-30 times more dangerous to carry a fetus to term than to undergo a legal abortion 10-30 times more dangerous to carry a fetus to term than to undergo a legal abortion

39. Facts re Abortion No long-term emotional or psychological sequelae No long-term emotional or psychological sequelae Women denied abortions often experience resentment and distrust Women denied abortions often experience resentment and distrust Their children may face social and occupational deficiencies Their children may face social and occupational deficiencies

40. Barriers to Abortion: Scare Tactics, Misinformation, and Pseudoscience Neither medical nor surgical abortion increase subsequent risk of ectopic pregnancy, spontaeous abortion, preterm birth, or low birth weight Neither medical nor surgical abortion increase subsequent risk of ectopic pregnancy, spontaeous abortion, preterm birth, or low birth weight No overall effect on the risk of breast cancer No overall effect on the risk of breast cancer NCI removed information re abortion and breast cancer from website; later posted unsupported “data controversial” statement NCI removed information re abortion and breast cancer from website; later posted unsupported “data controversial” statement C.f., NIH and CDCP websites removal of information about the effectiveness of condoms and sex education curricula C.f., NIH and CDCP websites removal of information about the effectiveness of condoms and sex education curricula

41. Abstinence-Only Education 77% of Americans have had sexual intercourse by age 20 77% of Americans have had sexual intercourse by age 20 Federal government spent $178 million in 2008 Federal government spent $178 million in 2008 0% on comprehensive sex ed 0% on comprehensive sex ed Average number of lifetime sex partners: Average number of lifetime sex partners: Wealthy country = 10 Wealthy country = 10 Poor country = 6 Poor country = 6

42. Abstinence-Only Education 2% of school districts in 1988; 23% in 1999 2% of school districts in 1988; 23% in 1999 Over 80% of curricula, used by 2/3 of grantees, contain false, misleading, or distorted information about reproductive health Over 80% of curricula, used by 2/3 of grantees, contain false, misleading, or distorted information about reproductive health Does not decrease sexual activity, STD rates, teen pregnancies; does not increase use of condoms and contraceptives Does not decrease sexual activity, STD rates, teen pregnancies; does not increase use of condoms and contraceptives

43. Abstinence-Only Education c.f. “Virginity Pledges” c.f. “Virginity Pledges” 88% violated 88% violated Pledgers have identical STD rates to non- pledgers Pledgers have identical STD rates to non- pledgers Pledgers are less likely than other to use condoms and to be tested and diagnosed with STDs Pledgers are less likely than other to use condoms and to be tested and diagnosed with STDs - J Adol Hlth 2005;36:271-8

44. Abstinence-Only Education Prohibits any discussion of contraceptives beyond failure rates Prohibits any discussion of contraceptives beyond failure rates Presents worst case scenarios of abortions and STDs Presents worst case scenarios of abortions and STDs Since 2001, success defined as “completion of a course,” rather than by actual outcomes Since 2001, success defined as “completion of a course,” rather than by actual outcomes Some states have refused abstinence-only funding Some states have refused abstinence-only funding

45. Abstinence Only Education: Examples Bizarre scare tactics: Bizarre scare tactics: “Today being an adult means being able to … participate in any and all types of perverse activities that depraved minds can imagine.” “Today being an adult means being able to … participate in any and all types of perverse activities that depraved minds can imagine.” Errors: Errors: “Studies show that five to ten percent of women will never again be pregnant after having a legal abortion.” “Studies show that five to ten percent of women will never again be pregnant after having a legal abortion.”

46. Abstinence Only Education: Examples Sexism/Sex Stereotypes: Sexism/Sex Stereotypes: “Deep inside every man is a kinght in shining armor, ready to rescue a maiden and slay a dragon.” “Deep inside every man is a kinght in shining armor, ready to rescue a maiden and slay a dragon.” “Females have the uncanny ability to remember the most insignificant details about past experiences.” “Females have the uncanny ability to remember the most insignificant details about past experiences.” “Men tend to be more tuned in to what is happening today and what needs to be done for a secure future.” “Men tend to be more tuned in to what is happening today and what needs to be done for a secure future.”

47. Father-Daughter Purity Balls Growing phenomenon Growing phenomenon More than 4,000 in U.S. (2007) More than 4,000 in U.S. (2007) Involve rings, roses, vows, and stereotypes Involve rings, roses, vows, and stereotypes

48. Comprehensive sex education programs Delay onset of intercourse Delay onset of intercourse Reduce the frequency of intercourse Reduce the frequency of intercourse Reduce numbers of sexual partners Reduce numbers of sexual partners

49. Comprehensive sex education programs Increase condom and contraceptive use. Increase condom and contraceptive use. Reduce numbers of unwanted pregnancies Reduce numbers of unwanted pregnancies Supported by large majority of Americans Supported by large majority of Americans

50. Barriers to Abortion: TRAP Laws Targeted Regulation of Abortion Providers Laws Targeted Regulation of Abortion Providers Laws Regulate hallway corridor and door frame width, temperature of operating rooms, numbers of hours of training each staff member much receive, increase licensing fees, impose burdensome documentation requirements, etc. Regulate hallway corridor and door frame width, temperature of operating rooms, numbers of hours of training each staff member much receive, increase licensing fees, impose burdensome documentation requirements, etc.

51. Barriers to Abortion: State Laws States enacted 34 new anti-choice measures in 2002, bringing the cumulative total to 335 since 1995 States enacted 34 new anti-choice measures in 2002, bringing the cumulative total to 335 since 1995 In 2003, 20 states introduced 37 bills criminalizing harm to an embryo or fetus In 2003, 20 states introduced 37 bills criminalizing harm to an embryo or fetus

52. Barriers to Abortion: State Laws Banning Abortion In 2003, 10 states introduced 15 measures that would ban all or most abortion In 2003, 10 states introduced 15 measures that would ban all or most abortion In 2005, a Michigan anti-abortion law passed, prohibiting physicians from performing most abortions, even when the mother’s health or life is endangered In 2005, a Michigan anti-abortion law passed, prohibiting physicians from performing most abortions, even when the mother’s health or life is endangered It is currently held up in federal court It is currently held up in federal court

53. Barriers to Abortion: State Laws Banning Abortion 2006 – South Dakota voters reject measure to ban abortion 2006 – South Dakota voters reject measure to ban abortion No exception for rape, incest or to protect woman’s health; contains inadequate and poorly-worded exception for “life endangerment” No exception for rape, incest or to protect woman’s health; contains inadequate and poorly-worded exception for “life endangerment” Violation is a felony Violation is a felony 2008 ballot initiative to outlaw “partial birth abortion” also failed 2008 ballot initiative to outlaw “partial birth abortion” also failed Similar bills have been introduced in Alabama, Georgia, Indiana, Kentucky, Ohio, Mississippi, Rhode Island, South Carolina, Tennessee, and West Virginia Similar bills have been introduced in Alabama, Georgia, Indiana, Kentucky, Ohio, Mississippi, Rhode Island, South Carolina, Tennessee, and West Virginia

54. South Dakota’s “Informed Consent” Law Passed in 2005 Passed in 2005 Planned Parenthood sought and received injunction to suspend Law Planned Parenthood sought and received injunction to suspend Law 6/08: Eighth Circuit Court of Appeals (Planned Parenthood Minnesota v. Rounds) lifted injunction 6/08: Eighth Circuit Court of Appeals (Planned Parenthood Minnesota v. Rounds) lifted injunction

55. South Dakota’s “Informed Consent” Law: Requirements Physician must give pregnant women a description of scientifically-unsupported “risks of abortion” Physician must give pregnant women a description of scientifically-unsupported “risks of abortion” Women must be told that they have an “existing relationship with fetus that enjoys protection under the U.S. Constitution and under the laws of South Dakota,” and that abortion terminates that relationship terminates that relationship along with “her existing constitutional rights with regards to that relationship” Women must be told that they have an “existing relationship with fetus that enjoys protection under the U.S. Constitution and under the laws of South Dakota,” and that abortion terminates that relationship terminates that relationship along with “her existing constitutional rights with regards to that relationship” Neither the Constitution nor SD laws explicitly mention such a relationship Neither the Constitution nor SD laws explicitly mention such a relationship

56. South Dakota’s “Informed Consent” Law: Requirements Disclosures must be made in writing, and women must sign each page of the state-crafted script Disclosures must be made in writing, and women must sign each page of the state-crafted script Physicians who do not satisfy statute subject to license suspension or revocation and may be charged with a class 2 misdemeanor Physicians who do not satisfy statute subject to license suspension or revocation and may be charged with a class 2 misdemeanor Physicians thus must violate Hippocratic Oath and lie to patients or violate SD law and face sanctions and possible prosecution Physicians thus must violate Hippocratic Oath and lie to patients or violate SD law and face sanctions and possible prosecution

57. Insuring Fetuses Bush administration pushing “adopt the unborn” campaign, extending State Children’s Health Insurance Program (SCHIP) to fetuses Bush administration pushing “adopt the unborn” campaign, extending State Children’s Health Insurance Program (SCHIP) to fetuses But full prenatal care not extended to all women But full prenatal care not extended to all women

58. Barriers to Abortion: “Partial Birth Abortion” Ban Criminalizes intact dilatation and extraction Criminalizes intact dilatation and extraction 0.17% of all abortions 0.17% of all abortions No exceptions for health of woman No exceptions for health of woman 31 states have such bans 31 states have such bans Similar 2000 Nebraska state law found unconstitutional by U.S. Supreme Court (Stenberg v. Carhart) Similar 2000 Nebraska state law found unconstitutional by U.S. Supreme Court (Stenberg v. Carhart)

59. Barriers to Abortion: “Partial Birth Abortion” Ban Lawsuits filed to overturn Lawsuits filed to overturn SF Appeals Court blocked administration enforcement of act against Planned Parenthood Clinics and their doctors, who perform roughly ½ of the nation’s abortions SF Appeals Court blocked administration enforcement of act against Planned Parenthood Clinics and their doctors, who perform roughly ½ of the nation’s abortions

60. Barriers to Abortion: “Partial Birth Abortion” Ban 2007: US Supreme Court upholds ban (Gonzales v. Carhart) 2007: US Supreme Court upholds ban (Gonzales v. Carhart) Physicians subject to 2 years in prison, fine of up to $250,000, and monetary damages for psychological injury to the husband or parents of the pregnant woman Physicians subject to 2 years in prison, fine of up to $250,000, and monetary damages for psychological injury to the husband or parents of the pregnant woman

62. Barriers to Abortion: Legal Unborn Child Pain Awareness Act Unborn Child Pain Awareness Act Mandates that women seeking abortion after 20 weeks be provided specific information regarding fetal pain during abortion, and that they sign a form accepting or refusing “pain medications for the unborn fetus” Mandates that women seeking abortion after 20 weeks be provided specific information regarding fetal pain during abortion, and that they sign a form accepting or refusing “pain medications for the unborn fetus”

63. Barriers to Abortion: Legal – The Courts Nominations of anti-choice judges Nominations of anti-choice judges ?Supreme Court nomination(s)? ?Supreme Court nomination(s)? ?Overturn Roe vs. Wade? ?Overturn Roe vs. Wade?

64. Bush Nominates First-Trimester Fetus To Supreme Court – The Onion, 9/05

65. Barriers to Abortion: Political Appointments Political appointments to government scientific organizations/committees based on ideology, not knowledge and experience Political appointments to government scientific organizations/committees based on ideology, not knowledge and experience E.g., Drs. David Hager, Susan Crockett and Joseph Stanford appointed to the FDA’s Reproductive Health Drugs Advisory Committee E.g., Drs. David Hager, Susan Crockett and Joseph Stanford appointed to the FDA’s Reproductive Health Drugs Advisory Committee

66. Barriers to Abortion: Political Appointments Example: Ob/Gyn Hager Example: Ob/Gyn Hager Author of “As Jesus Cared for Women” Author of “As Jesus Cared for Women” Has advocated Scripture reading and prayer for PMS and reportedly refuses to provide contraceptives to unmarried women Has advocated Scripture reading and prayer for PMS and reportedly refuses to provide contraceptives to unmarried women Accused by wife of “serial anal rape” Accused by wife of “serial anal rape”

67. Barriers to Abortion: Global “Gag Rule” First adopted by Reagan Administration in 1984 First adopted by Reagan Administration in 1984 aka Mexico city policy aka Mexico city policy Rescinded by President Clinton in 1993 Rescinded by President Clinton in 1993 Reinstated by Bush in 2001 Reinstated by Bush in 2001

68. Barriers to Abortion: Worldwide Abortion on request permitted in only 22% of countries worldwide Abortion on request permitted in only 22% of countries worldwide 6% of developing countries 6% of developing countries 1/3 of developing world lives where abortion is prohibited or allowed only in cases of rape or incest or to save the mother’s life 1/3 of developing world lives where abortion is prohibited or allowed only in cases of rape or incest or to save the mother’s life

69. Barriers to Abortion: Worldwide Lack of access to contraception Lack of access to contraception Average number of lifetime abortions: Russia (9), Romania (18 - pre-fall of communism) Average number of lifetime abortions: Russia (9), Romania (18 - pre-fall of communism) 100 million women have an unmet need for contraception 100 million women have an unmet need for contraception Catholic Church opposes contraception (even condoms) Catholic Church opposes contraception (even condoms) However, selective abortion of female infants common (e.g., 119F/100M live births in China) However, selective abortion of female infants common (e.g., 119F/100M live births in China)

71. Perspective: Poverty and Priorities Amount of money needed each year ( in addition to current expenditures) to provide reproductive health care for all women in developing countries = $12 billion Amount of money needed each year ( in addition to current expenditures) to provide reproductive health care for all women in developing countries = $12 billion Amount of money spent annually on perfumes in Europe and the U.S. = $12 billion Amount of money spent annually on perfumes in Europe and the U.S. = $12 billion

72. Conclusions Restrictions on access to abortion and other reproductive health services have increased dramatically over the last 8 years, particularly under the Bush administration Restrictions on access to abortion and other reproductive health services have increased dramatically over the last 8 years, particularly under the Bush administration Backed by inflammatory/hostile rhetoric and pseudoscience Backed by inflammatory/hostile rhetoric and pseudoscience

73. Conclusions Vigilance and legislative efforts at federal and state level and in the courts necessary to preserve and protect women’s right to choose Vigilance and legislative efforts at federal and state level and in the courts necessary to preserve and protect women’s right to choose

74. References Donohoe MT. “Teen Pregnancy: A call for sound science and public policy,” in Current Controversies in Teen Pregnancy and Parenting, Lisa Frick, Ed. (Farmington Hills, MI: Greenhaven Press/Thomson Gale, 2006). [Reprinted from Z Magazine 2003 (April);16(4):14-16. Available at http://zmagsite.zmag.org/Apr2003/donohoe0403.html] Donohoe MT. “Teen Pregnancy: A call for sound science and public policy,” in Current Controversies in Teen Pregnancy and Parenting, Lisa Frick, Ed. (Farmington Hills, MI: Greenhaven Press/Thomson Gale, 2006). [Reprinted from Z Magazine 2003 (April);16(4):14-16. Available at http://zmagsite.zmag.org/Apr2003/donohoe0403.html] http://zmagsite.zmag.org/Apr2003/donohoe0403.html Donohoe MT. Increase in obstacles to abortion: The American perspective in 2004. J Am Med Women’s Assn 2005;60(1)(Winter):16-25. Available at http://www.amwa- doc.org/index.cfm?objectid=1B138032-D567-0B25- 57EE86AC69902184 Donohoe MT. Increase in obstacles to abortion: The American perspective in 2004. J Am Med Women’s Assn 2005;60(1)(Winter):16-25. Available at http://www.amwa- doc.org/index.cfm?objectid=1B138032-D567-0B25- 57EE86AC69902184http://www.amwa- doc.org/index.cfm?objectid=1B138032-D567-0B25- 57EE86AC69902184http://www.amwa- doc.org/index.cfm?objectid=1B138032-D567-0B25- 57EE86AC69902184

75. References Adams KE, Donohoe MT. Reproductive Rights – Commentary: Provider willingness to prescribe emergency contraception. American Medical Association Virtual Mentor 2004 (Sept.);6(9). Available at http://www.ama- assn.org/ama/pub/category/12783.html Adams KE, Donohoe MT. Reproductive Rights – Commentary: Provider willingness to prescribe emergency contraception. American Medical Association Virtual Mentor 2004 (Sept.);6(9). Available at http://www.ama- assn.org/ama/pub/category/12783.htmlhttp://www.ama- assn.org/ama/pub/category/12783.htmlhttp://www.ama- assn.org/ama/pub/category/12783.html Donohoe MT. Obstacles to abortion in the United States. Medscape Ob/Gyn and Women’s Health 2005;10(2):posted 7/7/05. Available at http://www.medscape.com/viewarticle/507404 Donohoe MT. Obstacles to abortion in the United States. Medscape Ob/Gyn and Women’s Health 2005;10(2):posted 7/7/05. Available at http://www.medscape.com/viewarticle/507404 http://www.medscape.com/viewarticle/507404

76. References Donohoe MT. Parental notification and consent laws for teen abortions: overview and 2006 ballot measures. Medscape Ob/Gyn and Women’s Health 2007. Posted 2/9/07. Available at http://www.medscape.com/viewarticle/549316. Donohoe MT. Parental notification and consent laws for teen abortions: overview and 2006 ballot measures. Medscape Ob/Gyn and Women’s Health 2007. Posted 2/9/07. Available at http://www.medscape.com/viewarticle/549316. http://www.medscape.com/viewarticle/549316

77. Contact Information Public Health and Social Justice Website http://www.phsj.org martindonohoe@phsj.org