Thursday, December 30, 2010

How can we prevent abortion?

I've been having a discussion on another blog about abortion and reproductive rights. While we disagree on most aspects of these loaded topics, we agreed to try to find consensus. We agreed that reducing the number of abortions was a beneficial goal, and to wit Leila has been gracious enough to present her 3 (really 4) suggestions. My discussion follows. At some later date, I'll present my 2 or 3 suggestions as well. She says:

How can we prevent abortions?

1) Make it illegal. We are a civilized society, and barbarism should not ever be enshrined in law, especially when it targets the most vulnerable and voiceless among us.

2) Teach virtue. Sex is sacred. It has purpose. Sex leads to babies and teens (and adults) must be retaught this. We have bought the lie that only "unprotected sex" leads to babies, which is a whole other post. So, virtue. Chastity. Do not have sex till you can accept the baby that will come with it.

3) Promote intact, two-parent families. The single mothers, the fewer men who take responsibility, the more poverty, the more abortions. Two parent, intact families.

Teach those three things and mean it, and you will have DRASTICALLY reduced the abortion rate.

Oh, and one more thing: Teach science and biology. Make sure we all see lots and lots of ultrasound photos of the unborn, and make sure we all understand that (as you know), science has long ago determined that human life begins when the sperm meets the egg to form a new individual human being.

Yep, that ought to do it! Agreed?

The short answer is yes. We agree! (on some issues). The long answer is, alas, more complicated.

Defining the issues

Like many movements, the abortion rights movement was based on compassion. Women were being injured by illegal abortions, and organizers wanted to make it safe by taking it out of the alleys. I know this is nothing new and I know that the anti-choice community thinks this is misguided compassion. The only reason I bring this up is to point out the positive intention of the pro-choice movement, which is important.

Ok, so chastity, virtue and two-parent families. Yes, yes and yes (most of the time, assuming no spousal abuse.) Nothing in the abortion rights movement prevents the promotion of these beneficial attributes to personal and social hygiene. I think the case has been made, and continues to be made. To live a virtuous life is uncomplicated and affirming regardless of your belief system.

I suppose we can draw a correlation to Roe v Wade as the beginning of the breakdown of these virtues: If not for Roe, many assume we'd have no abortion, or surely less abortion. But is that what the empiric evidence shows? Was Roe the cause of the breakdown of virtue/chastity? Or was it an effect?

Making Abortion Legal

Roe was a response to unwanted pregnancy which has always been present, and increasing; women were attempting abortion at a greater rate which was leading to morbidity, pain and cost when those abortions were done wrong. Accurate demographics of botched abortions at the time are nonexistent, but anecdotal accounts are gruesome:

Desperate women used a number of dangerous means to terminate pregnancies. Some sought abortions from back-alley abortionists, with usually humiliating and sometimes deadly results.

Other women tried to induce abortions with homemade means--such as a bleach douche, or inserting sharp instruments into her cervix. This is why the now almost forgotten image of the wire coat hanger became the symbol of the abortion rights movement.

"In Chicago, at Cook Country Hospital, there were about 5,000 women a year coming in with injuries bleeding resulting to illegal abortions, mostly self-induced abortions," Leslie Reagan, the author of When Abortion Was a Crime, said in an interview. "They had an entire ward dedicated to taking care of people in that situation. Those wards pretty much closed up around the country once abortion was legalized."

The goal of the abortion rights movement in the 60's and 70's was to reduce the preventable morbidity associated with abortion. But preventing such morbidity certainly has increased the number of fetuses being aborted, right? We are merely exchanging one pathology for another, no? Well, that's a good question that may not have a clear intuitive answer. Statistics about abortion pre-Roe are difficult to decipher since we cannot know exactly how many abortions were being done surreptitiously, but we can try.

Estimates of the number of illegal abortions in the 1950s and 1960s ranged from 200,000 to 1.2 million per year. One analysis, extrapolating from data from North Carolina, concluded that an estimated 829,000 illegal or self-induced abortions occurred in 1967.

One stark indication of the prevalence of illegal abortion was the death toll. In 1930, abortion was listed as the official cause of death for almost 2,700 women—nearly one-fifth (18%) of maternal deaths recorded in that year. The death toll had declined to just under 1,700 by 1940, and to just over 300 by 1950 (most likely because of the introduction of antibiotics in the 1940s, which permitted more effective treatment of the infections that frequently developed after illegal abortion). By 1965, the number of deaths due to illegal abortion had fallen to just under 200, but illegal abortion still accounted for 17% of all deaths attributed to pregnancy and childbirth that year. And these are just the number that were officially reported; the actual number was likely much higher.

Simple arithmetic: The 829,000 illegal abortions in 1967 before Roe, added to the 2061 legal abortions performed in 1967, would give an abortion ratio (abortions per 1000 live births) of 23.6, compared to an abortion ratio of 23.3 in 1977, four years after Roe. This is in the ballpark of the current rate of abortion, assuming the population growth of the United States. So did Roe cause an increase in abortions? My conclusion, based on this admittedly incomplete data set, is no.

Legalizing abortion has reduced morbidity and mortality in women with unwanted pregnancy, but apparently has not increased the abortion ratio. Cook County Hospital no longer has a ward dedicated to managing complications from abortions gone awry. The abortion ratio peaked at 30 in 1980 and fluctuated in the teens an twenties over the subsequent decades. In the 2000's the ratio has been consistently in the teens; that low rate may be due to incomplete reporting, such as with the increasing use of medical terminations, or better and more available birth control, or social, religious and cultural factors (see below) .

Of course, we can argue that while physical morbidity may have decreased, we have done nothing for the emotional anguish of women aborting fetuses. Even the most strident pro-choice advocate would admit that abortion is not an optimal intervention. Even when done as safely as possible, medical complications can occur. Even when medical complications do not occur, emotional and psychological sequelae, often unquantifiable and unpredictable, may ensue.

At some later date, I can walk through the consequences of making abortion illegal again. Unsurprisingly, mMy conclusion is that most prohibitions probably would not have a material effect on abortion rates, but could increase morbidity in the pregnant woman.


The Chastity Argument

The concept of chastity has been around for a long time and, as Leila says, it has merit. But if that were the universal understanding, if it's such a great idea, then why doesn't everyone remain chaste? Yeah, this usually brings up the argument about Hollywood, television, the media, absent parents, and the loss of faith in God. If only we could correct these horrors, the First Amendment be damned, we'd have a Renaissance of virginal children growing up into monogamous spouses who stay married forever and have sex only for procreation, and the desire for abortion would be eliminated... just like it was in the good ol' days. I doubt that the good ol' days ever existed, at least for any sustained period of time, and it certainly is not what we see today. Or, alternatively, maybe today is as close we get to the good ol' days?

My grandfather would say to me, "Be good, and if you can't be good, be careful; and if you can't be careful, then name it after me." Then he'd smile, draw on his fat cigar and go back to his crossword puzzle. Message received: our actions have consequences, and as much as I loved my grandfather I did not want to change diapers on his namesake.

With such compelling reasons to avoid unwanted pregnancy, the emotional issues of promiscuity, the potential for disease, why hasn't the whole chastity thing caught on? I don't have one answer, but it likely has to do with a combination of our limbic system, or maybe the lack of fear of the negative consequences, or the endemic disbelief that some omniscient supernatural being is judging our bad behaviors. Even my sainted grandfather, who never missed Sunday Mass, did not appeal to the alleged omniscient Father in heaven to affect my behavior. Or, maybe it has caught on and this is about as chaste as our society will ever be.

No discussion of chastity would be complete without discussing abstinence-only education. Studies (1, 2, 3) have disputed the efficacy of such an approach. And while one recent study has indicated a marginal benefit, the study was flawed since it did expose the participants to non-comprehensive information about contraception, and the benefit was short-lived with 1/3 of abstinence-only participants engaging in sexual activity at the 2-year mark. Abstinence-only is a quantum event: either you do it all the time, or it fails.


Other issues

I'm blogged out for now,and have other things to do, but certainly Leila's desires for the "promoting two-parent households" (however we could do it?) and science education (including comprehensive sex education?) are valid. Those discussions will need to wait for now. Certainly there are ways to decrease the numbers of abortions, and we should continue to look for consensus on effective ways to reduce the numbers of abortion. What do we do right? What do other nations do right? What works and what doesn't?


JoAnna said...

There's considerable debate about the issue of deaths from illegal abortions. This page presents an argument with your numbers.

Regardless, it'd be like making robbery illegal so less people get shot while robbing banks. It's not right, ethically, to make something that's inherently wrong and unjust legal just so it'll be safer. If a woman seeks an abortion and has complications resulting in her death, that's a sad consequence of her illegal actions, just as if someone chooses to rob a bank and gets shot by the police in the process, it's a sad consequence of his/her decision to rob a bank.

Anonymous said...

Briefly to respond to JoAnna: It is NOT simply a "sad consequence" to die from seeking medical treatment. I know you don't consider abortion a medical treatment, perhaps teeth cleaning isn't really a medical treatment either? or pre-natal care after the discovery of pregnancy?

Great post Tony. While I have no problem perse with teaching abstinence, I do not think it is beneficial to teach abstinence only. In high school, as kids prepare for college, working/studying abroad, finding an apartment, and beginning their lives as young adults, I think it is extremely important to at least know and be familiar with birth control methods, abstinence, sex, babies and birth. Being confused about all of the above ad not having an opinion about the information I've listed leads to irresponsibility.

Leila @ Little Catholic Bubble said...

If I had know, I would have been more careful with my grammar on that comment! :) Darn!

All this is so very interesting, but it begs the question. Why, if abortion is moral (a woman's right), should we work to make it rare?

Of course, Tony, you know abortion is wrong. That is clear from our exchanges. You should come back to the traditionally liberal stance on abortion, and defend in law the right to life of the weakest, most defenseless members of the human family.

Another thought: If we were debating slavery (and abortion is analogous, since the unborn are seen as "property" and denied the right to life), you would never talk about ways to "reduce" slavery while keeping it legal. You would first admit that the law should protect the slaves by outlawing slavery. Then, if slavery persisted in some areas (as slavery still does, even in my own nation), we could all discuss how to bring the rates down even further. But first, you have to have a law acknowledging that slaves are human with human rights.

Leila @ Little Catholic Bubble said...

Anonymous, abortion isn't medical treatment because killing isn't healing.

JoAnna said...

Anonymous, as Leila said, abortion is not medical treatment. Pregnancy is not a disease; it's a natural biological process that occurs after a sexual act. In most cases, a woman seeking an abortion is trying to essentially erase the natural consequences of a consensual sexual act.

Leila @ Little Catholic Bubble said...

Ok, so chastity, virtue and two-parent families. Yes, yes and yes (most of the time, assuming no spousal abuse.) Nothing in the abortion rights movement prevents the promotion of these beneficial attributes to personal and social hygiene.

Actually, this is wrong. You need to check out Planned Parenthood's teen outreach (have you read teenwire???) as well as pro-choice feminist literature. When these groups actively fight against chastity, traditional families and virtue, and when that is promoted in the schools, then our side and theirs are opposing forces.

Tony said...

Leila and JoAnna,
I respect your position on abortion, I just happen to disagree with the issue of criminalizing it.

I admire our society when we are compassionate toward vulnerable members and provide such services as prenatal care, adoption services, food stamps and WIC. And we do. If we didn't do this, and allowed abortion as the only option, then I would have a problem. If we provided publicly funded abortion without medical indication, I would have a problem.

I'm not here to defend Planned Parenthood, but I see nothing in their literature that prevents you or any other organization from promoting two-parent families, chastity and virtue. My Toyota mechanic doesn't make sure I know the rules of the road. The beauty part of having your own kids is that you can raise them whatever way you want. Maybe we should ask why the virtues of chastity are not being taught effectively before the kid ends up at Planned Parenthood.

I honestly don't see the slavery analogy, but I'll think about it. Tell me when the human embryo/fetus is a completely separate entity from the mother. At birth, viability, 2nd trimester, conception? Even if we agreed that that moment of autonomy was conception (which is hard for me to fathom), could one say that abortion is unethical, but not criminal?

Personally, I believe that we as a society could do more to prevent abortion, to reduce the number of abortions, and I think this would be a prodigious benefit to society. We need to ask why our abortion rate is higher than other industrialized nations, but we also need to realize that even under perfect circumstances, the abortion rate will never be zero.

I appreciate our discussion on the issue, and especially appreciate your passion and know that it's difficult to see something you feel as a grave injustice perpetrated.

Leila @ Little Catholic Bubble said...

Tony, I still don't understand why someone's lack of "independence" makes him less worthy of protection and care?

Also, why do you think abortion should be rare? If you say "because it's unethical", then why is abortion unethical?

I see that you have a heart for the unborn, and I see that you want to be compassionate to the women with crisis pregnancies (me, too). But I think you are trying to find a way to defend something which you know is immoral.

Leila @ Little Catholic Bubble said...

PS: I am grateful for your thoughtfulness in this discussion.

Tony said...

As the SCOTUS says, the rights of the pregnant woman are taken into account, and since the embryo/fetus is dependent on her for life support, and that necessarily poses a risk to the pregnant woman, then the rights of the embryo/fetus can be abridged by the pregnant woman. (I'm neither a lawyer nor a writer, so pardon the run-on sentence.)

Is abortion a moral act? Morality is difficult to legislate, first off, which is why the legal language is tortured. But beyond the legal mumbo-jumbo, morality implies a personal coda, and that by necessity is determined by the individual. All recognized philosophies and religions allow for intent when considering whether an act is moral or not.

In a practical sense, I would find it impossible for one individual to be able to adequately judge the intent of another, especially a pregnant woman.

So having said all that, why do I feel that the number of abortions is too high? For example, in an abundant culture, with vast social safety nets, belief is strained that a pregnant woman would be morally justified to have an abortion solely for financial reasons.

Likewise, the intent of the abortionist would need to be considered, and if one is doing thousands of abortions on women he does not know very well (ie, Nathanson), then the assumption is that he/she is doing it for another intention than to relieve suffering (ie, financial gain), and that goes against medical ethics. There is virtually no physical way an individual doctor can perform 75,000 abortions in an moral or ethical manner (IMO), so no wonder the guy was distraught.

Can abortions be done morally, with justifiable intent? Yes, but I believe (ie, my opinion) that the number is lower than those performed today.

Furthermore, the vast majority of abortions are done on unwanted pregnancy (not for maternal or fetal indications), so the obvious way to reduce the number of abortions would be to reduce the number of unintended pregnancies.

Leila @ Little Catholic Bubble said...

Tony, it still begs the question: WHY do you think abortions should be rare? WHY?

Nathanson oversaw 75,000 abortions (in his clinics, and many by his own hand). Could he have overseen, say, 30,000 abortions in an ethical or moral manner? What number is ethical? Is it really about a number?

I could say so much more to what you wrote, but let's start with those questions.

(Also, intent is only ONE of the conditions we evaluate to see if an act is moral. I could murder my husband or children with good intent, but that wouldn't make the act moral. The means has to be moral, the end has to be moral, and the intention has to be moral.)

By the way, every law is legislated morality. What do you think laws against stealing or murder are?

Sorry, so much more that I want to address in what you wrote, but I will leave it at that and await your response.

Tony said...

"I could murder my husband or children with good intent, but that wouldn't make the act moral. The means has to be moral, the end has to be moral, and the intention has to be moral."

Why not? It might not be legal, but it could still be moral. I can't think of a hypothetical case for that particular example, but the classic case of killing potentially being moral is self-defense, or national defense.

Morality is a personal designation.

Why are murder and robbery illegal? This goes to the basic question of "What is the purpose of laws?" Various opinions can be found: protect individuals, protect property, encode behavior...

The answer I remember from my basic poli-sci college course (and I'll have to look for a reference), is that laws are created "to preserve and protect the Sovereign", in our case, our Government; in a kingdom, it would be the King/Queen.

Why are robbery and murder illegal?Because their presence threatens the Sovereign with social/political unrest. Laws are made to prevent injustice only so far as the Sovereign is benefited.

There's probably more, but that's the nutshell.

Leila @ Little Catholic Bubble said...

Tony, my gosh, that is just frightening. I can't get over that atheists think that the state is the highest power and authority. Don't you think your dignity (and your right to life itself) comes from something that transcends the government?

I'm sorry, but that is just so.... awful. I am so glad my rights don't come from other men. As Stacy says, that's being a happy and willing slave.

I know of a man in town who killed his wife and two small boys (and then himself) because he didn't want them to suffer through a bankruptcy. Clearly, his intent was to love and protect them. Was his action moral? Of course not, and you know it. Intent CANNOT be the only consideration of what makes an act moral.

Leila @ Little Catholic Bubble said...

So, stealing is not a moral issue?

Also, I don't think you answered WHY abortions should be rare?

Leila @ Little Catholic Bubble said...

And let me get this straight: Laws are about protecting the government, and not the people?

Tony said...

"...your dignity (and your right to life itself) comes from something that transcends the government?"

Yes, my dignity, my morality, is separate from our laws. Some I agree with, others I do not. Morality is a personal issue. That makes me "awful"? Geesh.

We have been flipping back and forth between legal rights and morality, so it's confusing. Certainly I do not think that everything that is legal is necessarily moral and vice versa. I just got done saying that I thought that many abortions were immoral.

Tony said...

Our govt is our people.

Tony said...

So, stealing is not a moral issue?

For me it is. Is it for you?

But our laws don't rely on whether someone feels stealing is immoral, we just make it illegal for the benefit of the Sovereign (ie, us.)

Tony said...

I know of a man in town who killed his wife and two small boys (and then himself) because he didn't want them to suffer through a bankruptcy. Clearly, his intent was to love and protect them. Was his action moral? Of course not, and you know it. Intent CANNOT be the only consideration of what makes an act moral. "

That certainly wouldn't be moral for me, and it apparently isn't moral for you.

But I don't care if it's moral for him... it's illegal, so he goes to jail. We don't have to waste our time wondering if it's immoral for him

"Morality" is a personal designation. "Rights" are a legal designation. We have to be clear on the terms.

Euthanasia is an example where someone could very well feel it's moral to reduce suffering. I know how I feel about that, and I know the law. They might be different.

Leila @ Little Catholic Bubble said...

Sorry, but my brain is trying to wrap my mind around all of the implications.

Morality is subjective, laws change, sometimes laws are moral, but since morality is subjective, then maybe laws can be moral and immoral at the same time, depending on the person? It could be moral to murder my family, but it's illegal, at least until the government (i.e., the people) say that it's legal to murder family members (Sharia?), and then it would be legal and moral (well, I guess it could be moral to the killers, legal to everyone, but immoral subjectively to some?).


Tony said...

Good job. You got it!

Personally, I would have left out the word "subjective", but if it works for you, go for it.

Leila @ Little Catholic Bubble said...

Wow, okay! Wow. Can I use that (and your caveat about "subjective") on a blog post?

Also, why would you leave out subjective?

(And, just to confirm, you are okay with Sharia Law being moral for those who are living in Muslim nations? Mercy killings, lashings for women, etc.?)

Leila @ Little Catholic Bubble said...

Tony, you might like this conversation between my beloved Dennis Prager and atheist Sam Harris. They actually agree on some things, and I want your take on it....

Tony said...

I don't know anything about Sharia law, but what you describe would not fit into my personal morality... lashing people does not comport with my interpretation of natural law.

If Sharia is the law of the land in Gumballistan, then it's legal there.

"Subjective" is not the proper word in that context.

Lisa Graas said...

Love them both. Mother and child. Voil'a! Problem solved!

Okay, next question.

Leila @ Little Catholic Bubble said...

Killing Jews was legal in Nazi Germany. Lots of bad things are legal in North Korea. But you can't say those things are wrong, correct? Not according to your philosophy (which is subjectivism, and I'm not sure why you resist the word).

You are a moral relativist, right? What is moral for you is not moral for me, etc.? Your truth is yours, my truth is mine?

So, I'm shocked to read that you believe in Natural Law? Explain?

Tony said...

Can't read Harris/Prager now, but I will tomorrow. Going out to dinner...

Yes, Harris has been writing about a secular morality and a secular spirituality... it should be interesting. I think the time has come for non-theists (more palatable term than atheists) to better define their interpretation of natural law. The problem is that non-theists rarely agree with each other, disdain any authority, and it's might be like herding cats.

Thanks for the link, I'll catch up with you tomorrow... next year.

Leila @ Little Catholic Bubble said...

Happy New Year!

Tony said...

OK, we're back to killing Jews...{sigh}...

It might be time to re-define terms. What do you mean by morality, or what makes an moral or immoral?

Leila @ Little Catholic Bubble said...

Moral, immoral
Right, wrong
Good, evil

But I can't debate on multiple blogs... I wish I could but I would spread myself too thin. So, it's back to my blog I go. Hope to see you there!

Leila @ Little Catholic Bubble said...

PS: My Jewish husband gets the correlation between killing "less than human" Jews and killing "less than human" unborn babies. I wish you did.

Tony said...

For the record, I asked 7 Jewish friends and colleagues and none agreed with the comparison of abortion to the Holocaust. One called the prospect "interesting" as he scratched his beard; three others shook their heads in disgust and one called the analogy "insulting." Don't kill the messenger of this admittedly unscientific study.

It's important to define morality as a personal versus a group designation; Stanford dictionary of philosophy says it can be either. One's intent is paramount, as in punishing a child either out of anger (immoral), or to improve his behavior (moral). Likewise, an abortion to save the life of a pregnant woman, or to reduce the suffering of a nonviable fetus, would be moral; performing thousands of abortions whereby proper counseling and diagnosis would be impossible is immoral.

You might disagree, and you might pejoratively call this moral relativism, but I would hardly call it "frightening" or "awful".

You've asked several times why I think abortion should be rare; I've answered it several times, and in the body of this blogpost. The ACOG also gives it's policy statement.

Leila @ Little Catholic Bubble said...

Tony, most Reformed Jews are very pro-choice. Were you talking to religious, Orthodox Jews? I doubt it.

I would love your take on my latest post, as it does touch on the question of how we prevent abortions.

I will check the body of this post again to see why you think abortion should be rare.

Moral reasoning has always held that for an act to be moral, three conditions (not just one or two) must exist:

The means must be moral.
The ends must be moral.
The circumstances must be moral.

Killing of the innocent can never be a means to even a good end.

Leila @ Little Catholic Bubble said...

I couldn't sign into the ACOG site, by the way.

Leila @ Little Catholic Bubble said...

I'm sorry... It must be me, but I can't find anywhere where you explain why abortion should be rare.