Bizarre Things Purported to Cause Autism: Hormonal Contraceptives

EXECUTIVE SUMMARY: An article published last winter in Medical Hypotheses suggests that long-term use of hormonal contraceptives might raise the likelihood of one's future children being born autistic. There is no good reason to believe this; the only things the article offers as potential reasons for it are 1) a very tenuous temporal relationship between widespread contraceptive use and a later (much later) rise in autism prevalence; 2) a misinterpreted bit of information largely pertaining to fertility testing; and 3) "What If?" scenarios involving epigenetics. I am worried about potential political fallout, to the further detriment of children and teenagers' sex education in the US, should this idea be uncritically popularized.
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Of all the myriad forms anti-feminist backlash can take, anti-contraceptive fearmongering is probably the most irritating to me.

So when I stumbled across this appalling article in Medical Hypotheses while I was casting about for items to populate my list of proposed causes of autism, I knew I would have to write a post specifically addressing this one.

The author, Kim Strifert, says that it may be possible that taking combined oral contraceptives (the ones that include both an estrogen, typically ethinyl estradiol, and a progestin, like levonorgestrel, norethindrone, or any of these others) over a long period* of time can change the conditions inside the ova and perhaps trigger epigenetic modification of genomic DNA.

I'd love to go into more detail about how this is supposed to work, but I can't, because no such detail is provided in the article:

Given the lack of research on the effects of oral contraceptive use on progeny, it is impossible at this point to specify a mechanistic link between oral contraceptives and autism. This fact represents a meaningful limitation to the hypothesis presented in this review. However, recent research already suggests that the current understanding of the pharmacology of oral contraceptives may be over-simplified. It has been proposed, for example, that epigenetic side-effects of pharmaceuticals may be involved in the etiology of cancer, heart disease, neurological and cognitive disorders, obesity, infertility, and sexual dysfunction [7][PDF]. It has also been suggested that epigenetic assays be incorporated into the safety assessment of all pharmaceutical drugs, which might lead to new mechanistic insights in the future [7]. Finally, new evidence is emerging that oral contraceptive use directly and deleteriously affects both the ovaries and the ova [8]. Thus, we are at a point where some concrete mechanistic hypotheses may be achievable in the near future.

What she does offer in support of her hypothesis is summarized here:

• Temporal correlation between use of oral contraceptives and increased prevalence of ASD.

• To date no definitive cause or contributing factors for increase in ASD prevalence has been established.

• Oral contraceptives disrupt the endocrine system -- COC's are endocrine disruptors.

• Oral contraceptives directly and deleteriously affect both the ovaries and ova.

• Likely effects of oral contraceptives on progeny are an open question.

• The called-for [by Dr. Roy Hertz**] further study and controlled follow-up of the possible transgenerational effects of oral contraceptive use has not been executed.

I will address these one at a time.

The first bullet point, the temporal correlation between use of oral contraceptives and autism prevalence, is true enough, but there are temporal correlations between lots of unrelated things. There's a whole mess of 'em archived for educational and comedic effect at Tyler Vigen's website Spurious Correlations. A cursory look at that website should be all the explanation you need of why this is not very good evidence that the two variables actually have anything to do with one another.

And even if we ignore that aspect of it, the time frames of the two trends -- increasing oral contraceptive use over time and increasing prevalence of autism over time -- don't quite overlap the way we would expect them to if there really were any sort of cause-and-effect relationship between them.

If there were such a relationship, we would expect a graph showing autism prevalence rates to be sort of a muted echo of a graph showing oral contraceptive use -- lower numbers overall, and trailing by maybe 5-10 years, but roughly the same shape, with peaks corresponding to peaks in the contraceptive-use graph.

Instead of that, we see two graphs of very different shapes, with their peaks separated by a much wider margin than would be possible if Strifert's hypothesis were true.

I cannot find comprehensive data on how many women used The Pill for every year between 1960, when it was approved, and now, but I can cobble together enough information from several different places to sketch a rough outline.

A very, very loose sketch of oral contraceptive usage in the US between 1960 and 2010, stitched together from numbers provided by PBS, the CDC (PDF, PDF), the Kaiser Family Foundation and the Guttmacher Institute

I can't vouch for the strictest accuracy of this picture, but the overall shape -- up, up, up, then slowing down, then a dip, then holding steady at about 10 million -- I'm reasonably confident in. 

By way of contrast, here is a graph of autism prevalence rates from 1985 to 2012 that Emily Willingham made:

Autism prevalence, 1985-2012, by Emily Willingham

As you can see, the shapes are very, very, very different! The graph of oral contraceptive use starts shooting upwards immediately, and then slows down its rate of increase, and then hits its peak and flattens out, while the graph of autism prevalence rises very slowly before it finally begins to build up steam. Like a logarithmic vs. an exponential*** curve...

They both trend upward, but other than that, they have little in common.

Even more important than the shape is the timing. Oral contraceptive use seems to hit its peak around the mid-to-late-1970s, while autism prevalence has perhaps not even peaked yet. It has a long, slow rise with what appear to be two inflection points, one around 2001 and another at about 2005.

Twenty-five years is an awfully long lag time between getting on the Pill and having young children. My mom could easily have been taking the Pill in the mid-1970s, and she had me thirty years ago! And I was diagnosed in 1989 or 1990, when the graph of autism prevalence was still hugging the x-axis.

The women making up that first big wave of oral contraceptive users are probably more likely to be the grandmothers of the children making up the present Autism Epidemic than they are to be their mothers.

The second bullet point is not really an argument in support of a causal relationship between contraceptive use and autism in progeny -- it's just saying, "Well, we don't know what causes autism, so why not entertain my idea?"

The third bullet point -- that hormonal contraceptives are endocrine disruptors -- is kind of a tautology. Of course they are endocrine disruptors -- they wouldn't be able to suppress ovulation if they were not.

Pointing out that hormonal contraceptives are endocrine disruptors is about as helpful as running up to someone and announcing that the Tylenol they are about to take will interfere with their body's natural warning system by dulling their sensations of pain. They know that; that is why they're taking the pill in the first place!

Finally, let's return to the first passage I quoted, which is the first mention of bullet point #4, "[o]ral contraceptives directly and deleteriously affect both the ovaries and ova." The source Strifert gives for this statement -- the "new evidence" that is "emerging" -- is this article on the biotechnology news website BioscienceTechnology.com.

What that article says is very different from what Strifert seems to think it says.

Prolonged hormonal contraceptive use does indeed shrink the ovaries, lower the levels of anti-Müllerian hormone in the blood, and reduce the number of ovarian follicles at a certain stage of maturation. Those two things are considered reliable indicators of how many egg cells might be left within the ovary.

(Here is a literature review comparing the relative merits of those two biomarkers)

However, the researchers who discovered this -- Dr. Kathrine Birch Petersen and her team -- do not think these effects are permanent, and are mostly concerned with making sure people getting their fertility tested after just coming off of birth control get an accurate estimate of their ovarian reserves. Dr. Birch Petersen is especially worried that this temporary suppression of ovarian-reserve markers by long-term contraceptive use might mask a naturally low ovarian reserve, something a person wishing to become pregnant would want to know about.

Here she is, quoted in the Bioscience Technology article:

Birch Petersen's team does not believe these changes [decreased ovarian volume, lower AMH levels, lower antral follicle count] are permanent. But as a result of the study, she said, women in the Pre-conceptional Care Program who have been on the contraceptive pill are now advised that their ovaries may look older and smaller, and may possess only a few small antral follicles, with low levels of AMH for a time after stopping. They are told this likely does not affect future fertility for most women. 

But it could matter for women undergoing premature menopause. Naturally diminished ovarian reserves could be masked by the above. It is therefore possible ovarian reserve assessment should be repeated after stopping birth control pills. 

"Worldwide, 160 million women are on the pill," Birch Petersen told Bioscience. "One percent will go into early menopause before the age of 40. The pill can mask the symptoms of early menopause, and this is why women should consider repeating the tests after six months [off the pill], if they have a low ovarian reserve." 

Next up, says Birch Petersen: "To examine what happens with the ovarian reserve parameters after one, three, and six months."

And here is a short press release published last year on the Clinical Endocrinology News website:

Oral contraceptives do more than prevent unwanted pregnancy. They also make it harder to gauge a woman's ovarian reserve, based on data from 833 women aged 19-46 years seen at a single Danish fertility clinic. 

Study findings suggested that an accurate measure of a woman's ovarian reserve can occur only after she has been off an estrogen-containing [oral contraceptive], probably for at least 3 months, Dr. Kathrine Birch Petersen reported at the annual meeting of the European Society of Human Reproduction and Embryology. 

The impact of estrogen-containing OC use on reducing ovarian volume was especially pronounced in women under 30, the reduction increased with longer durations of OC use, and the ability of OC's to mask a woman's actual ovarian reserve was strong enough to potentially conceal a true case of premature ovarian insufficiency, said Dr. Birch Petersen, an ob.gyn. at the Fertility Assessment and Counseling Clinic at Righospitalet in Copenhagen. 

"When we see a woman on an OC with impaired ovarian reserve, we would presume [based on these new findings] that her real ovarian reserve was about 30% higher than what we measure. We would advise her to be retested after she was off her OC for about 3 months," Dr. Birch Petersen said during a press conference before her presentation at the meeting. 

The study included the first women seen at the clinic since it opened in 2011, excluding those who were pregnant or failed to supply adequate information. The cross-sectional cohort included 240 women on estrogen-containing OC and 593 women with natural cycles. 

The analysis focused on three parameters: blood level of anti-Müllerian hormone (AMH), antral follicle count (AFC), and ovarian volume. The multivariate, linear regression analysis adjusted for age, body mass index, smoking, age of maternal menopause, maternal smoking during pregnancy, preterm birth, and duration of OC use. 

The analysis showed that compared with the women with natural cycles, those on an OC had a 19% relative reduction in their average blood level of AMH, a 16% reduction in average AFC, and a 47% relative reduction in average ovarian volume. The women on an OC also had smaller antral follicles. All three differences were statistically significant. 

Seeing an effect from an estrogen-containing OC on all three measures makes sense because of their interrelatedness. The antral follicles produce AMH, and a reduction in antral follicle number as well as size would shrink the ovarian contents and result in reduced volume. These results would not occur in women on a progestin-only OC, she said.

This additional context makes it clear to me that the changes wrought on the ovary by estrogen-containing contraceptives are indeed temporary.

And here is one more thing I wonder -- why autism? Why would the kind of epigenetic interference Strifert seems to be postulating only result in one type of developmental disability? I know autism is a broad category, but still -- why would only development of the nervous system be affected? Why not all aspects of fetal development?

(A cynic's response to that question would be, because autism is the biggest cultural bogeyman with which to threaten prospective parents. See also: the anti-vaccine movement.)

I would not be opposed to any of the further research into contraceptive safety, uterine and ovarian physiology, or potential alternative methods for contraception!

Even though I do not think it likely at all that what she suspects is true, I think that only good could come of additional efforts to develop even safer methods of contraception that work in multiple different ways.

But what I do not want to happen, which I strongly suspect would be a more likely near-term consequence of Strifert's article gaining widespread attention, is for her warnings to be hyperbolized (instead of the question "what is the effect of long-term hormonal contraceptive use on the ova?" it would become the statement "using hormonal contraceptives means that your children will be born with developmental disabilities later on") and be taught to teenagers in sex education classes as yet another reason they should eschew any and all birth control methods. Sex education classes in the US already lie to children about the efficacy of condoms and tell them that total sexual abstinence is the only way to protect themselves, so adding one more lie to the list is hardly unthinkable.

And looking at the path Strifert's ideas have taken into the blogosphere, this impression -- that, far from echoing her call for more research and development of new contraceptive methods and for improved safety of existing methods, the blogs reporting on her article merely urge their readers to eschew hormonal methods of contraception entirely.

The only blog post I could find dealing with this specific article is this one, by Dr. Kelly Brogan, MD, who despite her medical training seems to reject all of modern, conventional medicine in favor of diet and lifestyle changes.

There are other posts that express a similar idea -- that birth control pills can cause autism in one's future children -- but credit a different source and propose a different mechanism by which it happens (usually gut bacteria rather than the epigenetic explanation loosely sketched by Strifert); those blogs are about an even mix of anti-vaccine, alternative medicine blogs that advocate rejection of all conventional medicine and Catholic blogs that reject all methods of contraception except Natural Family Planning and abstinence.

I do not think it is irrelevant that those are the types of the blogs on which this particular Bizarre Autism Hypothesis has appeared.


*Pun intended

**In a 1966 report by the U.S. Food and Drug Administration's Advisory Committee on Obstetrics and Gynecology; that report, physically archived at the University of Michigan, has been digitized and can be viewed online here.

***Or, what is more likely, a logistic curve. Populations cannot grow indefinitely.

Jerk Tweets Sexist Remark, Prompts Me to Muse About the Meaning of "Freedom"

"Feminism is the radical notion that women are people" - Cheris Kramarae and Paula Treichler

It took a long time before this saying made any sense to me. Surely everyone knows that women are people, right? What else would they be? Space aliens? Robots? Very convincing holograms?

That was a joke --- I knew, even when I first heard the saying, that it was referring not to the tautology that female Homo sapiens are Homo sapiens, but to the philosophical concept of personhood. At the time, though, I couldn't imagine that anyone did not extend personhood fully to women, so the saying still struck me as bizarre.

Well, here is a wonderfully clear example of someone doing just that:

Tweet from Pax Dickinson saying "Women's suffrage and individual freedom are incompatible. How's that for an unpopular truth?" Image taken from the Public Shaming tumblr

This guy was, until recently, the Chief Technology Officer at Business Insider, a popular news website with an emphasis on business and technology (particularly information technology) news.

But I don't care so much about who the speaker is so much as I do about what he is saying: Women's suffrage and individual freedom are incompatible. What? People are freer when fewer of them can vote? How does that make any sense?

I would submit that it only makes sense when you assume that the "individuals" he's talking about are men. Women's freedom is compatible with women's suffrage --- see recent elections in which women's votes made the difference between a Republican rape philosopher and a more liberal (if not always pro-choice) Democrat.

Women's votes made the difference in 2012 in the Indiana U.S. Senate race between Richard Mourdock (the "pregnancy from rape is God's will" guy) and Joe Donnelly*, in the Connecticut Senate race between Linda McMahon and Chris Murphy**, in the Massachusetts Senate race between Scott Brown and Elizabeth Warren***, in the Ohio Senate race between Josh Mandel and Sherrod Brown****, in the Pennsylvania Senate race between Tom Smith and Bob Casey*****, and in the Virginia Senate race between George Allen and Tim Kaine. 

Women's votes failed to make the difference in the Wisconsin Senate race between Tommy Thompson and Tammy Baldwin, and in the governor's races in Montana and Washington --- if only women had voted, the Democratic candidates would've won those races, but the Republicans' advantage among men was strong enough to carry them to victory anyway.

(It should be pointed out that, for the most part, abortion and other "women's issues" do not drive the gender gap in voting behavior --- there are much bigger differences between the sexes on whether to strengthen or cut back the welfare state and whether to pursue a hawkish or dovish foreign policy, according to Rutgers University's Center for American Women and Politics. The hard-right candidates that women voters rejected in 2012 espoused both extreme anti-abortion, anti-contraception positions and a desire to greatly diminish the welfare state, so it's hard to tell whether their anti-choice zealotry was the deciding factor in alienating women voters. But the fact remains that, if only men had voted, a lot more of those anti-choice zealots would be sitting in Congress today.)


So, besides being more likely to vote against candidates looking to curtail their reproductive freedoms, women also vote for candidates they think will strengthen the social safety net. What does that have to do with personal freedom?

Well, I think having a robust social safety net is critical for maximizing individual freedom: there are a lot more choices available to you if you don't have to worry about losing your home and being unable to feed yourself and your family if you lose your job. You're more free to blow the whistle if you think your employer is doing something unethical, to fight against what you see as unfair or exploitative working conditions, and to engage in political activism or commentary outside of work without being afraid that these things will cost you your job. You are also more free to leave a job for whatever reason. There's a reason FDR named "freedom from want" as one of his Four Freedoms, and why he used that word --- freedom --- instead of, say, "rights" or "entitlements" or "needs."

There's also a subset of welfare-undermining measures that serve only to criminalize poverty, to subject people needing government assistance to intrusive, degrading treatment and erode their freedom. Things that fall into this category are mandatory drug testing for welfare recipients, requiring welfare recipients to document that they spent a certain number of hours each week either working or engaging in approved job-seeking or job-preparatory activity, tying the amount of money a family receives to how well their children are doing in school, or requiring people applying for welfare to be fingerprinted.

People who favor such mean-spirited measures usually think there are legions of idlers living on welfare just because they don't want to work, and spending their benefits on luxury items. 

(They are mistaken --- almost every form of public assistance that exists in the US is time-limited or situation-specific, like unemployment insurance (which expires after a certain number of weeks that varies by state), the program people are usually thinking of when they say "welfare" (which is officially called TANF: Temporary Assistance for Needy Families, which has, among many other limitation, a five-year lifetime cap on benefits), or WIC (which you can only get if you are pregnant, nursing, or have children younger than five years old). The one program that doesn't come with a predetermined expiration date is food stamps, which you can only get if you make 130% of the federal poverty rate or less, and which you can only use to buy food).

But whether or not the idlers exist, it's important to focus on the fact that these people --- the people who favor draconian measures to curb welfare fraud --- are more concerned with ferreting them out than with getting aid to those who need it, and subjecting those people to minimal state intrusion and hassle. That does not sound like a person who is concerned with human freedom; to me, that sounds a lot more like a person who cares little for people and a whole lot for pinching pennies.

There are some personal-freedom issues on which women tend to favor more restrictive policies than men do: according to this poll, women are less likely than men to support legalizing marijuana, to give just one example. But the conclusion one draws from that, taking into account everything I've said above, isn't that men are pro-freedom and women are anti-freedom; it's that most people favor at least some restrictions on individual freedoms, and that there are some differences between the sexes in terms of what should be allowed and what should be forbidden. The only way you arrive at "Women's suffrage is incompatible with individual freedom" is by defining "individual freedom" so selectively as to leave out any personal-freedom issue on which women are more liberal than men.

*Donnelly is pro-life, but unlike Mourdock he would allow an exception to a general ban on abortion for victims of forcible rape. He also voted for the Affordable Care Act and for the reauthorization of the Violence Against Women Act.

**McMahon supported the Blunt amendment, which would've allowed employers to opt out of providing insurance coverage for contraception. She also wanted to repeal the Affordable Care Act, which is slightly more popular among women than among men (i.e., for women it's almost a 50/50 split, while men are opposed by a slim majority). 

***The biggest issue at stake in this race was obviously regulation and reform of the financial sector, which is not a "women's issue" but is, according to Rutgers University's Center for American Women and Politics, a greater priority with women voters than with men, though this poll shows huge majorities of both sexes favoring reform.

****Mandel seems to have campaigned on his opposition to the Affordable Care Act, and the fact that his opponent, Sen. Sherrod Brown, voted for it. Mandel also opposes abortion, same-sex marriage and including sexual orientation and gender identity in anti-discrimination laws. 

*****Casey is pro-life, but unlike Smith he would allow an exception to a general ban on abortion for victims of rape or incest, or if the life of the mother is in danger. He voted for the Blunt amendment, but has also voted to protect Planned Parenthood's federal funding under Title X, and to rescind the Mexico City Policy (aka the "global gag rule" forbidding aid organizations from even referring people for abortion services). He also supported the Paycheck Fairness Act and introduced a bill to require colleges to do more to prevent (and track, and prosecute) sexual assault and domestic violence. Smith, as I mentioned, favors a total ban on abortion with no exceptions, and is one of the lesser-known Republican rape philosophers.

Senator Envy

I am often envious of people living in other states, or even other parts of my state, for their awesome state senators and representatives.

As I live in the Kansas City Metro Area, I read a lot about Missouri Sen. Jolie Justus, who represents a district including parts of Kansas City, MO. She's an out lesbian, and the first openly gay member of the Missouri Senate. She also generally seems to look out for her poorest constituents; whenever I see her quoted in the Kansas City Star she seems to be talking about how such-and-such measure would affect the poor, the disabled, the homeless etc. She seems to want to make Missouri a kinder, gentler, more inclusive place.

I have also had reason to wish that I lived in a different part of Kansas, so that Kansas Sen. Marci Francisco would be my senator instead of Sen. Greg Smith. I wrote to both of them (and the rest of the members of the Natural Resources subcommittee of the Kansas Senate Ways and Means Committee) concerning an effort to reintroduce black-footed ferrets on private property in western Kansas, and a resolution their committee was considering that would oppose this effort. Sen. Francisco wrote back to me, and gave the impression that she was well-informed on the issue, and that she shared my concern that the resolution being discussed was written in a hugely misleading way. She also told me about several efforts she had made to change the language of the resolution by amending it, and that she would keep trying to edit out the parts that she thought were wrong. (Sort of hedging one's bets, is how I took it: the ideal outcome would've been for the resolution to fail, but if it looked like it might pass, it would be less hostile to the reintroduction effort than it would've been without her intervention. I can appreciate that.)

Now I have another state senator to covet and admire from afar: Texas Sen. Wendy Davis. She's filibustering a particularly draconian set of restrictions on abortion that would close the vast majority of Texas's abortion clinics. Should the bill become law, only five clinics (out of 47) could stay open, and those five are all clustered in the eastern part of Texas.

Map:

Map showing all clinics in Texas that offer abortion (top), and all of those clinics that meet the requirements laid out in SB5. Graphic made by Whole Woman's Health

Anyway, Sen. Davis is taking heroic measures to block this bill! She's been standing on the Senate floor and speaking since 11:18 this morning, and she's going to keep speaking until midnight tonight. She has had to stay in that spot for the whole ten hours she's been speaking, and will have to stay there for the two hours and forty-five minutes she still has to go. She can't stop talking, leave (even to use the bathroom), eat or drink. Republican senators have even called foul on her for wearing a back brace at one point in her filibuster. At least she's wearing good shoes!

I am in awe of how hardcore she is. I'm a lot younger than she is, and in good physical shape, but I don't think I could do what she's doing, even on a pure physical level. (Seriously. I can work outside for six, seven or eight hours in the hot sun, like when I dug an 80-foot-long, maybe 18" deep on average trench in my mom's backyard to put in a brick wall border for a giant flowerbed we're still filling up. Did that all by myself, during peak sun hours in a Kansas summer. It was probably high 80s or low 90s*. Yet I am probably 85%-90% certain I would collapse before the end of the twelve-hour, forty-two-minute filibuster she's powering through.) Obviously I wouldn't have the quick wits to come up with original, relevant content to fill a twelve-hour filibuster; apparently in real life you can't just grab the nearest book and start reading aloud.

*For any international readers I might have, those numbers are on the Fahrenheit scale. In degrees Celsius, it was probably 30-35. Hot by my standards, anyway. Some of you might scoff at that, but I am a transplant from further north, and I miss winter. 

Rhetorical Uses of the Budget Deficit

This might seem like small potatoes compared with everything else that's going on in Kansas now (which Shakesville has been chronicling), but it's a local story rather than statewide, and thus not going to get the same amount of coverage on the Internet as the Planned Parenthood defunding and the attempt to impose new regulations on abortion clinics, and I also think it's illustrative of a few things, so I'm going to write about it anyway.

The county commission of Johnson County, Kansas (where I live) has just accepted a $500,000 federal grant paying for abstinence-only sex education classes, but has refused the part of the grant subsidizing a more comprehensive sex-ed program (a series of videos) that emphasizes abstinence, contraception, condom use and basic sexual health, and is targeted at "at-risk" teenagers.

The comprehensive program was opposed by the anti-abortion activist group Kansans for Life, which says on its website that it suspects Planned Parenthood of being in some way involved in creating the videos:

One of the two programs --- the curriculum based on for 11-13 year olds, "Making a Difference," seems to be abstinence-based only ... . The one for "at risk" kids aged 13 to 19 revolves around a video named "What Could You Do?" (have a look HERE), which critics believe is inappropriate on its face because it includes a video that includes a couple in bed, has a heavy emphasis on condoms, and a segment with kids putting condoms on cucumbers.

... The point is that 'condom on cucumber' sex ed programs have long been the staple of Planned Parenthood. And, while the program for younger kids appears OK, and does show some effectiveness, is it possible for citizens to be assured that the Jo. Co. Department of Health, using our federal and perhaps state tax dollars, could or would be able to insure that those teaching the program don't use the opportunity to push Planned Parenthood or something similar?
...
... [W]e will be left with two alternatives. Either use all the grant money for the PREP program aimed at younger kids, with some kind of assurance that it will remain pure of Planned Parenthood or abortion influences or references, or ask that our commissioners once again reject this grant altogether.

(I always find it weird, the extent to which Planned Parenthood is seen as a boogeyman, a sort of Pied Piper of abortion, herding unwary girls and women by the score into its clinics. It's like a less overtly misogynistic version of that other widespread myth about abortion, the cartoonishly selfish woman who terminates pregnancies on a whim; only in this version it's the cartoonishly evil and predatory doctor who performs abortions on everyone who comes into his office, whether they want one or not. There also seems to be this idea that everything Planned Parenthood does, or oversees, is going to involve abortion. Which is not true --- most of what Planned Parenthood does has nothing to do with abortion; it's gynecological exams, testing and treatment for STDs, distributing contraception, help managing painful periods, or even giving prenatal care to pregnant women who want to have the baby!)

Kansans for Life's Executive Director, Mary Kay Culp, also brought up the national debt:

Culp and a few others cited the government's huge debt among the reasons for turning down the grant.

"We're borrowing money from China to put condoms on cucumbers," she said.

This is the part I mentioned at the beginning of the post, that I thought was "illustrative" of something. I've been noticing lately (and I haven't been the only one to notice) that concern about the nation's (or sometimes the state's) fiscal health seems to operate as a sort of rhetorical camouflage: when you couch your calls for all sorts of government programs and services to be eliminated in language of scarcity, or of a dire need for any and all cost-cutting measures, you make it harder to argue against them because the usual defense, "But [x] does a lot of good, and people need it!" doesn't refute "There is no money for [x]." If you want to refute that, you have to go a step further, and find a y that could be cut in x's place, yielding equal or greater savings. But usually the x's in this discussion are things that the people pulling the Deficit Gambit want to get rid of just because they don't agree with them philosophically, not because they constitute a serious drain on the budget.

(In this case, I think the Deficit Gambit is functioning a little differently since it is being used in addition to, rather than instead of, philosophical arguments. So I think its purpose is less to disguise the philosophical argument than it is to buttress it, especially to persuade people who might not accept any of the premises on which the philosophical argument is based).

S. 987 Vote: More Proof that "Pro-Life" Isn't About Protecting Children

Clarissa and Anthony McCarthy (at Echidne's blog) have both written about the U.S. House of Representatives' failure to pass a bill that would help protect young girls around the world from being forced into marriage, often to much-older men who will abuse them, rape them and force them to bear children before they are full-grown.

The International Protecting Girls by Preventing Child Marriage Act of 2010, or S. 987, passed unanimously in the Senate and had lots of support in the House, to the extent that it looked like it was going to pass easily. (As it should, since it's one of civilized society's major duties to protect its most vulnerable members --- children being among them --- from exploitation and harm). But in the hours leading up to the House vote, Rep. Ileana Ros-Lehtinen (a Republican from Florida) circulated a "Dear Colleagues" letter asking fellow Republicans not to vote for the bill, but instead to vote for an alternate version of it which she authored.

The full text of that letter is reproduced at the end of this post at RH Reality Check --- the gist of it is that Rep. Ros-Lehtinen believes that S. 987, as it was written, would cost too much, and that her own alternate bill would be cheaper to implement.

According to another Representative, Rep. Betty McCollum (a Democrat from Minnesota), there's no basis for this objection; she says the bill does not appropriate any new funds whatsoever. And, indeed, in my own perusal of the bill's full text (which is short), I could find no mention of money, or of things that cost money, like establishing new agencies, task forces or research initiatives. The text of the bill seemed to me to deal only in guidelines for allocating funding that already exists.

Anyway, hours after Ros-Lehtinen sent out her letter, just before the bill was to be voted on, Republican Majority Whip Eric Cantor sent out a "Whip Alert" (a short message telling rank-and-file party members what the party line is going to be) saying this:

Leadership and Ranking Member Ros-Lehtinen OPPOSE passage of S. 987, the International Child Marriage bill, because of cost and pro-life concerns.
...
S. 987 authorizes $108 million over 5 years without sufficient oversight of the taxpayers' money. According to the Congressional Research Service, there is no available, confirmed figure on how much taxpayer funding is already being used to fight child marriage in developing countries and this bill does not address that issue.
...
There are also concerns that funding will be directed to NGOs that perform abortions and [that] efforts to combat child marriage could be usurped as a way to overturn pro-life laws.

After receiving those two messages, almost all of the House Republicans (along with nine Democrats), did indeed vote "No" on S. 987. It still received a majority of votes --- 241 ayes and 166 nays --- but it wasn't a big enough majority to pass.

This is a truly mystifying outcome; not only does the bill not call for any new spending, it also doesn't say anything about abortion. On its face, this is actually a very pro-life bill: it protects children and aims to prevent unwanted pregnancies. Even Sen. Sam Brownback*, a very, very pro-life senator, not only voted for the Senate version of this bill, but he apparently worked very hard to get it passed, so important was it to his vision of a Culture of Life.

It looks to me like they derailed this important, necessary, moral bill out of sheer orneriness; non-cooperation for its own sake, and the consequences be damned.

*"God's Senator" --- many of whose policy positions I abhor, but whom I at least respect for being consistently pro-life, and having "pro-life" mean more than just "anti-abortion." He has written, sponsored and supported lots of humanitarian-aid legislation, and he's often willing to cross party lines to get that sort of thing done. I've voted for him as a Senator before for that reason, but after this session he's leaving the Senate to become Governor of Kansas. I do not think that will go well, at all.

Health Care for All --- Except You, Lady!

On Sunday, the House of Representatives passed the Democrats' health-insurance reform bill, but not without some "collateral damage," to use Echidne's phrasing.

The bill that was passed contained an amendment, the Stupak-Pitts amendment (full text here), which would bar any government-sponsored health insurance from covering abortions. More than that, it would require any private insurance plans that might receive government subsidies, or be purchased by individuals receiving government subsidies, to strip abortion coverage from their publicly available plans, and put it into a separate category of coverage that people would have to buy for themselves (or get through their employer).

The amendment would remove all references to abortion coverage from the parts of the bill describing "Essential Benefits" (Title II, Subtitle C) --- i.e., coverage to be extended to everyone, whether directly through a government-run public insurance option or indirectly through government subsidies or exchange programs intended to make private or employer-based insurance more generally accessible --- and add this text at the end of Title II (Protections and Standards for Qualified Health Benefits Plans):

SEC. 264. LIMITATION ON ABORTION FUNDING.

a) IN GENERAL. --- No funds authorized under this Act (or an amendment made by this Act) may be used to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion, except in the case where a woman suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the woman in danger of death unless an abortion is performed, including a life-endangering physical condition caused by or arising from the pregnancy itself, or unless the pregnancy is the results of an act of rape or incest.

b) CONSTRUCTION ON OPTION TO PURCHASE SEPARATE SUPPLEMENTAL COVERAGE OR PLAN. --- Nothing in this section shall be construed as prohibiting any non-federal entity (including an individual or a State or local government) from purchasing separate supplemental coverage for abortions for which funding is prohibited under this section, or a plan that includes coverage for such abortions, so long as ---

1. such coverage or plan is paid for entirely using only funds not authorized or appropriated by this Act; and
2. such coverage or plan is not purchased using matching funds required for a federally subsidized program, including a State's or locality's contribution of Medicaid matching funds.

c) CONSTRUCTION ON OPTION TO OFFER SEPARATE SUPPLEMENTAL COVERAGE OR PLAN. --- Notwithstanding section 303(b), nothing in this section shall restrict any [Qualified Health Benefit Plan] offering entity from offering separate supplemental coverage for abortions for which funding is prohibited under this section, or a plan that includes such abortions, so long as ---

1. premiums for such separate supplemental coverage or plan are paid for entirely with funds not not authorized or appropriated by this Act;
2. administrative costs and all services offered through such supplemental coverage or plan are paid for using only premiums collected for such coverage or plan; and
3. any nonfederal QHBP offering entity that offers a plan that includes coverage for abortions for which funding is prohibited under this section also offers a plan that is identical in every respect except that it does not cover abortions for which funding is prohibited under this section.

As Ezra Klein, Jodi Jacobson, and Jenn all point out, this will seriously aggravate the systemic inequality of access that already pervades both health care in general, and abortion and contraception in particular, in this country.

The Hyde amendment already barred women on Medicaid, women in (federal) prison, federal employees, and military personnel from receiving insurance coverage for abortion, and now the Stupak amendment will ensure that lots of other categories of women join them.

Robin Marty also points out that the amendment --- containing as it does such restrictive language surrounding when publicly-funded abortions are permissible --- could have the unintended consequence of forcing women who've miscarried to go through with their already-aborted pregnancies, because removing the dead fetus would technically be an abortion, and thus ineligible for public funding (or --- to reiterate, because I think this is the most invasive aspect of this law --- private funding by any insurance plan participating in a public insurance-exchange program or open to people receiving federal subsidies):

Hospitals and doctors in general do not have terminology to classify a difference between the termination of a live pregnancy and one in which the fetus has already died. To them, a D&C is a D&C, regardless of the state of the "conception materials" removed. Regardless of how many times I made sure to mention to the staff, either for the sake of my sanity or to spare me some sort of imagined shame, that I was ridding myself of my "dead fetus," to them it was all the same.

I also could not fail to notice the amendment's omission of mental illnesses from the list of acceptably serious health problems sufficient to justify terminating a pregnancy with federal assistance.

That omission is interesting to me, because pregnancies resulting from rape and incest are on the okay-to-abort list, even though such pregnancies may not be particularly dangerous or life-threatening. You might think that Rep. Stupak included those categories out of respect for the intense mental and emotional suffering a woman (or girl) is likely to feel, giving birth to her attacker's child, but then you wonder, if he really is so concerned about suffering, where's his consideration for women suffering suicidal depression, or terrifying psychotic breaks? Many psychiatric medications can't be taken during pregnancy, after all, and depression in particular can worsen dramatically as soon as the depressed pregnant woman gives birth.

Those incongruities suggest to me that either Rep. Stupak is really ill-informed about mental illness, pregnancy and women's health (which wouldn't surprise me --- Rep. Stupak is not a doctor), or he ascribes to the distressingly common, misogynistic view that women abort pregnancies on a whim, and that female sexuality, decoupled from marriage and socially-sanctioned procreation, is an inherently destabilizing force that must be contained.

If restricting abortion is not really about fetal life, but about female sexual agency, as Amanda Marcotte frequently --- and quite persuasively --- argues, then it makes sense that abortion bans almost always contain rape and/or incest exceptions. If the sex wasn't chosen, the woman isn't a threat; she's a pitiable victim. In the usual "elective abortion" narrative, a woman who chooses to have sex is obliged to accept the "consequences" of her decision --- i.e., pregnancy --- and any attempt by her to exert further control over her fate, say, by taking emergency contraception or, if she should become pregnant anyway, having an abortion, is an overreach; she sins, she cheats, she gets away with too much. Her impunity makes people nervous. The victim of rape or incest is not "overreaching" in this way; she's just trying to get back to normal.

The Slow Erosion of Hard-Won Freedoms

Via Pandagon, I found this jaw-dropping article in The Nation about crisis pregnancy centers, those innocuous-seeming places offering "alternatives to abortion."

Apparently, rather than give women the help they need to make their own choices, crisis pregnancy centers often coerce women into 1) having the baby, and then 2) giving the baby up for adoption.

This coercion might take the form of misinformation and scaremongering about abortion and single motherhood, of isolating her from her family and friends and hammering her with messages about her unfitness to be a mother, or even of denying a woman money she needs (like, say, reimbursing her for hospital bills she incurred during pregnancy and delivery) unless she agrees to give up her child:

When Jordan arrived [at Bethany Christian Services crisis pregnancy center in Greenville, South Carolina], a counselor began asking whether she'd considered adoption and talking about the poverty rates of single mothers. Over five counseling sessions, she convinced Jordan that adoption was a win-win situation: Jordan wouldn't "have death on her hands," her bills would be paid and the baby would go to a family of her choosing in an open adoption. She suggested Jordan move into one of Bethany's "shepherding family" homes, away from the influence of family and friends.
...
Bethany guided Jordan through the Medicaid application process and in April [of 1999] moved her in with home-schooling parents outside Myrtle Beach. There, according to Jordan, the family referred to her as one of the agency's "birth mothers" - a term adoption agencies use for relinquishing mothers that many adoption reform advocates reject - although she hadn't yet agreed to adoption. "I felt like a walking uterus for the agency," says Jordan.

Jordan was isolated in the shepherding family's house; her only social contact was with the agency, which called her a "saint" for continuing her pregnancy but asked her to consider "what's best for the baby." "They come on really prolife: look at the baby, look at its heartbeat, don't kill it. Then, once you say you won't kill it, they ask, What can you give it? You have nothing to offer, but here's a family that goes on a cruise every year."
...
Jordan selected a couple, and when she went into labor, they attended the birth, along with her counselor and shepherding mother. The next day, the counselor said that fully open adoptions weren't legal in South Carolina, so Jordan couldn't receive identifying information on the adoptive parents. Jordan cried all day and didn't think she could relinquish the baby. She called her shepherding parents and asked if she could bring the baby home. They refused, chastising Jordan sharply. The counselor told the people Jordan was having second thoughts and brought them, sobbing, into her recovery room. The counselor warned Jordan that if she persisted, she'd end up homeless and lose the baby anyway.

"My options were to leave the hospital walking, with no money," says Jordan. "Or here's a couple with Pottery Barn furniture. You sacrifice yourself, not knowing it will leave an impact on you and your child for life."

The next morning, as Jordan was rushed through signing relinquishment papers by a busy, on-duty nurse serving as notary public. As soon as she'd signed, the couple left with the baby, and Jordan was taken home without being discharged. The shepherding family was celebrating and asked why Jordan wouldn't stop crying. Five days later, she used her last $50 to buy a Greyhound ticket to Greenville, where she struggled for weeks to reach a Bethany post-adoption counselor as her milk came in and she rapidly lost more than fifty pounds in her grief.

When Jordan called Bethany's statewide headquarters one night, her shepherding mother answered, responding coldly to Jordan's lament. "You're the one who spread your legs and got pregnant out of wedlock," she told Jordan. "You have no right to grieve for this baby."

This story is almost an exact duplicate of the stories collected in Ann Fessler's The Girls Who Went Away: The Hidden History of Women Who Surrendered Children for Adoption in the Decades Before Roe v. Wade --- the helplessness, the loneliness and desperation Jordan felt going in; the "choices" she made because her alternative was homelessness; the utter refusal of the people at the adoption agency to treat her like a person, with interests and feelings of her own. Instead, they alternately praised her or demonized her: when she decided she would go ahead and keep the baby (after five sessions' worth of strongly pro-life, pro-adoption "counseling"), she was "a saint," but if she ever entertained other ideas, she became a selfish monster, either a murderer or a weak, childish woman who couldn't see past her own fleeting emotions to make The Right Choice.

The strength of these terms of praise or blame --- seesawing wildly between angelic and demonic --- is itself a pretty powerful persuasive tactic. First, remember that Jordan was living in a strange city in the home of the couple that was "shepherding" the adoption; most people want to be well-liked by the people they see every day, especially if those are one's only social contacts, as those people were hers. It would take an unusual degree of independence, emotional self-sufficiency and self-esteem to make a choice that everyone around you was telling you was a catastrophically bad idea: irresponsible, financially ruinous, destructive of the would-be parents' hopes and the child's future, and just plain selfish. Second, those extreme categories --- saint or monster --- and the nanofiber-fine line that seems to separate them serve, along with the dislocation and the isolation among near-strangers, to disorient Jordan and break down her will. Not being able to predict how an authority figure will react to what you say or do, especially when their reaction might be an angry one, makes most people especially anxious to stay on that authority figure's good side.

For comparison's sake, here are some descriptions of what giving a baby up was like from The Girls Who Went Away:

Any of my conversations I had with the social worker before giving birth were all basically trying to help me understand why I couldn't keep my son. Afterward, I had to go to the district court in Augusta and sign the papers. The judge was not friendly; he was being very businesslike. He put the papers in front of me to sign and I just kind of stood there. Finally I said, "What happens if I don't sign?" He got very angry and said that I'd already cost the poor, hardworking taxpayers enough time and trouble and if I didn't sign the papers he'd declare me incompetent, and how would I like my son to know that about me?

One of the questions that come up when you go to court and relinquish is they ask you if you have been coerced in any way, and I thought it was the height of hypocrisy. Of course, you're coerced. You're coerced by your parents, who said "Don't come home again if you plan to keep that child. We're not going to help you." You're coerced by everyone around you because of the shame and lack of acceptance by society and your community. You're not acknowledged as a fit mother because you had sex before marriage.

The judge congratulated me on how courageous I was. I was furious that he would tell me about courage. It was about defeat. It was totally about shame and defeat.

I stayed in the hospital about two days afterward and then it was this very strange Twilight Zone sort of time. I had to go back to the maternity home to collect my things, knowing what I knew. I couldn't say anything. They're all happy, happy, happy, chatter, chatter, chatter, and I've just experienced this loss. How could you tell people that? So I just became voiceless. I couldn't speak it. I really just kind of shut down.

I went back to Penn State. I started school again in four days. I finished school and then I was on to happily ever after. But I wasn't happy anymore. I mean, I realized there was something really wrong.

Now, these women gave up their babies as young, unwed women in their teens and early twenties in the 1950s and '60s, before legal abortion, contraception and the second wave of feminism. Few of them had any idea, before all this happened to them, exactly how sex and pregnancy even worked; they were not things that respectable people talked about.

For almost two decades now, conservative policymakers have been trying their hardest to bring back this set of circumstances. If overturning Roe itself isn't feasible, they've still managed to put as many barriers as humanly possible between women and abortion: mandatory waiting periods and counseling, parental notification laws, mandatory ultrasounds, etc. That's been going on since at least the 1990s, when the Hyde Amendment banned the use of government funds (i.e., Medicaid) to pay for abortions. A newer development is the attempt, through misinformation (abstinence-only and abstinence-plus sex education, which dwell on inflated failure rates of various contraceptive methods and urge students to stay celibate until they marry), to recreate the cultural climate of silence, shame and ignorance that kept unwed mothers so powerless in the first place.

Doctor Murdered by Terrorists

Via Shakesville and Pandagon.

Dr. George Tiller, a Wichita-based gynecologist who ran one of only two clinics in the state of Kansas that perform abortions, was shot outside Reformation Lutheran Church this morning.

The police have a suspect, Scott Roeder from Merriam, Kansas. (Merriam is a suburb of Kansas City, Kansas, neighboring the one in which I live).

Dr. Tiller has been shot at before: in 1993, the anti-abortion activist Shelley Shannon shot him twice, but he survived. His clinic is frequently picketed, and he's also been subjected to intense scrutiny by former Kansas attorney general Phill Kline, who seized the medical records of Tiller's patients to look for evidence of sexual abuse of underage girls --- this was seen by many people, including me, as a pretext to harrass Tiller and possibly close down his clinic, since an abortion clinic is hardly the only place one would look for underage rape victims, yet it seems to be the only context in which he mentioned this personal quest.

If I have anything substantive to say about this good, brave man's murder, it is this: There is no difference between the people who did this (and who bomb abortion clinics and stalk, harrass and murder doctors nation- and worldwide) and the Islamic terrorists who are supposed to be The Enemy.

None whatsoever.

Racial and Class Aspects of Homebirth

Via Feministing, I found this thought-provoking article by Miriam Pérez (who blogs at RH Reality Check, Feministing and Radical Doula) about additional barriers to safe, midwife/doula-assisted homebirth poor women and women of color face.

Some of those barriers are:

Lack of insurance coverage

"I work in a (very) low-income Medicaid clinic in Sacramento [California], and the women all have Medicaid or Family Pact as insurance," [Certified Professional Midwife JayVon] Muhammad explains. "Medicaid doesn't cover homebirth, so even if women choose to have homebirth, they are not covered, leaving no choice at all. As a result, when women show an interest, and very few do, they don't have a choice. They are forced (due to lack of money, and insurance) to deliver in the hospital."

Documentation worries

In recent years, particularly since 9/11, obtaining passports and other citizenship documentation has become increasingly difficult. The crackdown has focused on people born to midwives at home. Immigration authorities have begun questioning the validity of documents from these midwives and holding these individuals to a much higher burden of proof. This has had a disproportionate impact on Latinos and other immigrants, requiring them to go to great lengths to obtain passports and other documentation. [Washington, D.C. doula] Claudia Booker thinks this fear of citizenship being questioned may keep low-income people from leaving the hospital to give birth.

Lack of awareness

Doulas and midwives who work in low-income communities of color see the barriers as being social in addition to financial.
...
"My clients don't know a thing about homebirth, nor do they understand why they would even consider such a thing," explains Muhammad. "They are not educated about the benefits of birthing out of the hospital or birthing without interventions."

Experience of homebirth as something done because there was no other choice

Claudia Booker ... explains that women in low-income communities of color stopped giving birth outside of hospitals at least three generations ago. There is also a sense, she noted, that giving birth at home is "what poor people do and [that homebirth] was something we did because we had no option." This history reflects a larger transition among US women giving birth at home to hospital birth, which happened in the 1920s. Low-income communities, and particularly African-American ones, took longer to make this transition because of poverty, racism and lack of access to hospitals.

While for well-off white women, giving birth at home might sound like a way to take control over one's own pregnancy and delivery, and secure more choices, to poor women of color it could just as easily look like a loss of those choices they have only recently gained.

As one of the commenters points out, this reflects a "two-tiered system of giving birth in America." Of course, our entire health-care system is multi-tiered, with only the top tier providing anywhere near the level of care people need.

Read the whole thing!

Gratuitous Woman-Blaming: Even Progressives Do It

As I am likely to be moving to Tennessee in the not-too-distant future, I read this guest post at Shakesville with particular alarm. (Cross-posted from here).

Apparently there is a bill working its way through the Tennessee state legislature that would require all pregnant women who aren't seeing an OB/GYN for prenatal care all throughout their pregnancy, or whose pregnancies are "abnormal" in some way, to undergo drug testing.

Here's Aunt B's take on the bill's implications:

This bill would make mandatory drug testing for women who don't act right during pregnancy. If you don't get pre-natal care, the State [of Tennessee --- not the entire US, international readers!] wants the right to drug test you. If you don't come in for prenatal care promptly once the fetus is viable, they want the right to drug test you. If you don't get the right kind of prenatal care, they want the right to drug test you. In other words, if you act in any way "abnormal," the going assumption is going to be that you must be on drugs.

But here's the best part. If your pregnancy just isn't going right --- the placenta comes open or the fetus dies or you go into labor early for no discernible reason, or the fetus isn't growing fast enough, or the fetus has congenital anomalies --- and let me remind you that these are all things that just happen during pregnancies; things go wrong, for no reason, all the time --- the State wants to drug test you.
...
In other words, the precedent they're setting is that, once you are pregnant, your body is not your own. You no longer know what's best for you. Your doctor no longer knows what's best for you. You are not allowed to not realize you're pregnant. You're not allowed to be afraid. You're not allowed to be too poor to go to the doctor. You have to do what the State tells you to do while you're
pregnant, because, while you're pregnant, your body is not your own.

Here, from the text of the bill itself, is the list of "indications of the necessity for drug and alcohol testing":

(1) No prenatal care;
(2) Late prenatal care after twenty-four (24) weeks gestation;
(3) Incomplete prenatal care;
(4) Abruptio placentae;
(5) Intrauterine fetal death;
(6) Preterm labor of no obvious cause;
(7) Intrauterine growth retardation of no obvious cause;
(8) Previously known alcohol or drug abuse; or
(9) Unexplained congenital anomalies.

(I took #3, "Incomplete prenatal care," to encompass not only failing to see an OB/GYN all the way up to the birth, but also getting prenatal care from anyone who is not an OB/GYN --- like if you had decided to give birth at home with the help of a midwife or doula).

What's particularly mind-bending about this bill is that its sponsors --- Sen. Beverly Marrero (D-Memphis) and Rep. Jim Hackworth (D-Clinton) --- actually seem to be fairly progressive.

From a statement Marrero made on human rights:

As a Democrat, I support women being allowed to make choices about their own lives and bodies. These are painful and difficult choices. I support these women. I stand beside them in their struggle for self-determination.

As a Democrat, I am concerned about all children being nurtured and supported by a loving and compassionate community.

Aunt B mentioned in her post the likely reasoning behind someone like Marrero proposing this act: Memphis --- Marrero's home district of Shelby County in particular --- has appalling rates of infant mortality and premature birth.

Lack of access to prenatal care has a lot to do with it:

Prematurity is the No. 1 baby killer in Memphis and nationwide, accounting for at least 60 percent of the deaths.

In half those cases doctors don't know why the babies came early.

Poor women are more likely to deliver too early - between 20 and 37 weeks - and lose their babies. The odds are against them.

Their lives too often reflect the long list of risk factors.

Poor mothers are less likely to get prenatal care, less likely to eat right and get vitamins they need.

They're more likely to smoke, drink, use drugs, and suffer mental and physical abuse.

They're more likely to have unplanned or back-to-back pregnancies.

Poor mothers are more often high school dropouts and teenagers, more likely to live near toxic streams and dumping grounds.
...
"We've medicalized a social problem," [Nancy Lawhead, health policy assistant to Shelby County Mayor A C Wharton] said.

Memphis must find a way to infuse in its culture that teen pregnancy is a shackle to poverty, she said. That the surest way to freedom is family planning; that low education levels and no prenatal care can literally kill your baby.

In light of that, I can understand Marrero and Hackworth's desperation. But the way to combat the profound systemic inequalities at work here is not to penalize poor women for failing to get themselves into doctors' offices in spite of all the factors that work to keep them out. As Aunt B mentions in her post, this bill is not likely to get more drug-using moms-to-be to see doctors; if anything, it will keep them away for fear of testing positive and facing drug charges. (Also, as one of the commenters at Shakesville noted, opiate withdrawal is hell on even a nonpregnant body, so going into treatment to break the addiction --- which is what the law would mandate for women testing positive --- could actually jeopardize more pregnancies).

No, I think legislators like Marrero and Hackworth would be better served by putting their funding behind existing volunteer organizations that educate and advocate for pregnant women, or by beefing up state-funded healthcare. Using the law to make more choices available to poor women makes a lot more sense than using it to restrict their choices even further.