Pain in the Ass

An bill making its way through the Ohio legislature has attracted a lot of attention lately for proposing that abortions be outlawed after a fetal heartbeat can be detected - which occurs about 6 or 7 weeks after conception.  This law - HB 125 - is not only in direct defiance of Roe v. Wade (which mandates that abortion rights not be violated prior to viability, currently defined at 24 weeks of gestation), but was also recently the subject of a court case in which a pregnant woman was given a ultrasound in the courtroom when her 9-week-old fetus was called to "testify."

Similarly, many states require that a pregnant woman have an ultrasound and listen to her fetus' heartbeat prior to obtaining an abortion.  These ridiculous bills are founded on the sappily sweet "Touched by an Angel" sentiment that a beating heart on an ultrasound could never cause anything but joy and reverence.  Naturally, however, lots of organisms have circulatory organs just as complex as the heart tube found in the 7-week fetus:  the cattle and pigs we don't hesitate to slaughter for meat, for example.  Maybe McDonald's patrons should be legally required to listen to a bovine heartbeat before deciding whether to order a McRib.

As does a major myocardial infarction, fatass

What worries those of a slightly more scientific, less sentimental nature is the issue of embryonic brain development and fetal pain.  After all, no brain, no pain.  The fetal pain argument has recently led five US states (Kansas, Nebraska, Indiana, Oklahoma, and Idaho) to ban abortions after 20 weeks of gestation - once again, in direct opposition to Roe v. Wade.  Now, since I just finished writing a paper on fetal cortical development for my Developmental Biology course, I'll try to reproduce the gist of the argument here to dispel any and all concerns for fetal pain in abortion.

The cerebral cortex, the portion of the brain necessary for thought, language, and pain sensation, begins forming around 8 weeks post conception, when the anterior and posterior regions of the dorsal telencephalon start secreting signals to pattern the cortical layout.  From this point, cortical progenitor cells in the subventricular zone begin differentiating into glial cells and neurons, and neurons begin the process of migrating upward to the cortical plate.  Once they have reached their destination, they will undergo myelination and form synapses with other neurons, in a process which will continue throughout development and even after birth.

http://www.humpath.com/spip.php?article5287&id_document=4056

The brain of a 22-week-old human fetus

According to the Guttmacher Institute, 88% of abortions occur prior to 12 weeks of gestation.  At 12 weeks after conception, the regions of the cortex have been specified, but neuronal migration is just beginning, and will not be completed for at least another month.  The neuronal circuits that are needed for sensory perception will not form until much later, 24 weeks at the earliest.

Neurons beginning their migration

Neurobiologists are and have been in agreement that a fetus cannot feel pain prior to 24 weeks of gestation, since the circuits needed for sensation are simply not present before that time (seriously, no brain, no pain).  Less than 2% of abortions occur after 20 weeks of gestation, and abortions are performed after the 24-week mark only in the most dire of situations.  So, an aborted fetus can not and will not feel pain.  Questions answered?  Problems solved?  If only.

Mother's Day

Happy Mother's Day!  As I write this post, I am feeling pretty satisfied about the state of my life:  I sent my mom a homemade card, med school applications are underway, I am not myself a mother, and I might just have put my finger on exactly why the pro-life movement bothers me so much.

It came to me while I was thinking about my own sweet mother.  For years, this woman helped me with infernal science fair projects, drove me to violin lessons and birthday parties, and endured my tantrums with a patience that astounds me more and more the older I am.  She made sure that I ate my vegetables, paid for my braces, and allowed me to host slumber parties that would inevitably result in my giggling and screaming pre-pubescent friends running all over the house in the middle of the night.  Even now, almost a quarter century after giving birth to me, she pays for my education, sends me cute cards and letters "just because," and loses sleep over my well-being.   She does all this in spite of the fact that I am a legal adult.  And it's the same with my dad.  Parenthood really is a life sentence, or at least a binding contract.  

Pro-life protesters trying to deter women from entering clinics often call out helpful incentives to keep their babies, such as offers for a free baby blanket or pacifier.  This is a huge insult, as it implies that the pocket change needed to purchase baby supplies is the biggest obstacle an accidental mother will face.  Leaving aside the enormous financial investment that a baby requires, raising a child demands maturity, patience, stability, and life-long devotion.

http://cdn.keyj.com/files/2011/05/adult-baby-250x200.png

Not to be entered into lightly

The crisis pregnancy centers that manipulate women into becoming mothers and the pro-life activists who just succeeded in defunding Indiana's Planned Parenthood are, in essence, grossly undervaluing the enormous commitment that parenthood entails.  Parenthood doesn't end after a 9-month gestation, nor after 18 to 26 years of tax dependency.  While I'm celebrating my mother today for choosing to have me, I fully acknowledge that she didn't have to do so.  Women deserve every chance to decide whether to enter into the biggest (and longest-lasting) commitment of their lives.  And children deserve parents ready and willing to make that commitment.  

"Population," or "The World Is Not Enough"

When the Supreme Court delivered its famous Roe v. Wade ruling in 1973, it upheld a woman's right to choose based on the Constitution's guarantee of a right to privacy.  This makes perfect sense:  the prevention or termination of pregnancy is, and should be, a private matter, and thus the decision to end a pregnancy belongs to the woman alone.  I contend, however, that the opposite does not hold true:  the decision to give birth is not a matter of privacy.  A woman who has an abortion affects only herself; bringing another human being into the world, on the other hand, immediately impacts the mother, the newborn individual, the larger community, and the very fate of the planet.

The concept of a population's carrying capacity is something we all learned about in high school.  The idea is that a population of organisms will increase in size until it reaches a set number, determined by resource availability and competition pressure.  After this point, large scale death will prevent further population growth.  population size will oscillate around the point of the carrying capacity, but increased death rates and reduced reproductive fitness will not allow population size to increase further.

http://www.goldiesroom.org/Note%20Packets/22%20Ecology/00%20Ecology--WHOLE.htm

We usually discuss such concepts of population in relation to yeast cells, mice, deer, etc.:  organisms to which we have no particular emotional attachment.  We have to be a lot more careful, though, when talking about the growth of the human population, since most of what we do is already an effort to deny that we are, by definition, animals, constrained by biological precepts.  The notion that we are somehow different from yeast cells, mice, or deer is enforced by the observation that our population's growth curve currently shows no indication of approaching a carrying capacity limit.

http://www.bbc.co.uk/schools/gcsebitesize/science/aqa/evolution/humansrev1.shtml

The fact that our population's growth curve has so far been uninhibited by starvation or disease seems to be testament to our high level of "success," reproductively speaking.  Nevertheless, though our world population will reach 7 billion this year, hunger, disease, and conflict are still taking their toll, killing millions each year even as new births more than compensate for this loss.  A little less than half of the world's 7 billion people currently live on under 2 USD a day.  And these are the communities whose populations are growing the fastest.

In The Selfish Gene, Richard Dawkins advanced the idea that exercising moderation in reproduction could actually be evolutionarily advantageous.  Producing many more offspring than can survive under certain environmental conditions is, evolutionarily speaking, wasteful.  Likewise, reproducing at an unchecked rate will quickly deplete resources and is also a terrible evolutionary strategy.  For these reasons, the population of a certain organism will stay relatively constant over time, and when population pressure begins to increase, the organism will (unconsciously, of course) curb its rate of reproduction to avoid a dangerous scarcity of resources somewhere down the line.  

Human reproduction, however, has proceeded at an explosive rate, which Dawkins attributes to modern medicine, the welfare state, and complete failure to look to the future.  We may have been reproductively successful during the last five hundred years, but that is small change in the span of evolutionary time.  Our current reproductive strategy is, to say the least, unsustainable, and may prevent us from seeing another five hundred years.  As Dawkins says, "The one thing animal populations do not do is go on increasing indefinitely."

http://www.coverbrowser.com/covers/ballantine-books/14

Unfortunately, population discussions are not politically correct, and tend to conjure up dystopian images of calculated killings and mass sterilization programs.  Furthermore, the discomfort with the issue belongs to those at every stage along the entire political spectrum.  Regardless of the environmental or societal impact, argue conservatives and liberals alike, the human right of reproduction is too sacrosanct to curtail.  Thus we talk about population growth in positive, rather than normative terms:  "How will we emend farming techniques and colonize other planets to keep up with the human race's inevitable increase?" Yet the human population has the potential to double in less than a hundred years; we can't afford to be so magnanimous forever.  In a stand-off between biology and political correctness, biology will always prevail in the end.

A Hole in Our Rubber Soul

The simple mechanics of pregnancy prevention are straightforward and, luckily, cheap.  Nevertheless, though condoms are plentiful, easy to use, and ribbed, scented, and flavored, about fifty percent of American pregnancies are still unintended.  This is not, as many religious sources would have you believe, due to the incredibly high rate of condom failure.  Not surprisingly, it's the result of layer upon layer of prejudice and misinformation.  Several centuries after its invention, the rate of condom failure is still much lower than the rate of condom ignorance.

It begins with the way that the media depicts condoms, and the way that it presents sex.  Sex is everywhere on TV, including on the Disney Channel and the Food Network.  Yet condom commercials are much harder to come by. You certainly haven't seen them on ABC, home of the wholesome "Gray's Anatomy" an "Desperate Housewives," which refuses to air any condom advertising.  Other networks may allow condom advertisements, but most have restrictions on the types of commercials that can be shown, and the times that they can run.  Perhaps most egregiously, Fox and CBS mandate that any condom advertising shown on the network "must not focus on pregnancy prevention."  In the same way, birth control pills can be advertised, as long as they are marketed as primarily as treatments for acne and PMS.  Interestingly, these same restrictions do not apply to commercials for products such as Viagra or Cialis.

Condom Ad Rejected by Fox

I am certainly not belittling the importance of HIV prevention. Yet mandating that condom commercials focus only on disease prevention, and not on unwanted pregnancy, seems a bizarre dichotomy to draw.  In fact, prior to the emergence of the AIDS crisis, condom advertisements were not allowed on TV at all.  Focusing on HIV risk makes sex dirty and dangerous, while advocating pregnancy prevention would imply that fun, non-procreative sex is something to be celebrated.  I guess that Fox executives can congratulate themselves on having made pregnancy prevention an obscenity, and one even greater than sex itself.

The mere logistics of purchasing condoms is further testament to the disconnect between our views of contraception and our appetite for sex.  In most drugstores, condoms are segregated to a special shelf, usually right below the pharmacist's watchful eyes; in other cases, they are locked up, and store patrons must have an employee assist them in their embarrassing purchase.  It is awkward enough to remove condoms from their glass prison when you're in your twenties or thirties; I can only imagine how difficult it is for a 16-year-old to ask someone to unlock a condom case.  Unfortunately, condoms have been locked up primarily because they are so often shoplifted, likely by those too embarrassed to bring them to checkout.  Then the condoms are locked up, the awkwardness increases, and an infinite cycle begins.

http://thecurvature.com/2009/02/12/cvs-limits-condom-access-for-some/

These magical locked cases can only be opened with a wedding ring.

To better promote safe sex amongst teenagers, progressives such as Joycelyn Elders have advocated dispensing condoms in high schools.  Massachusetts has implemented this practice in many of its schools, with great significant reduction in teen pregnancy rates.  Yet I doubt that other states will take the cue from Massachusetts any time soon, because I'm just not that naive.  Indeed, the "War on Condoms" is being waged full-force in high schools, as well as in our drugstores an on our airwaves.

http://www.zazzle.com/if_used_correctlynot_100_effective_condoms_e_tshirt-235300270078506145

Seriously, ya'll!  If used correctly, not 100% effective condoms everytime!  Wait, what?

In the abstinence-only programs served up to most of America's teenagers, condoms are only mentioned as being so ineffective that they are not worthy of discussion.  This is the direct of the widespread fear that frank discussion of condoms will incite premature sexual activity, in the same way that not teaching teens about condoms has successfully kept sex a complete secret.  For this reason, teenagers educated in abstinence-only programs are far less likely than their more savvy counterparts to use condoms when they inevitably become sexually active.  I feel like it's understood that essentially all products have some non-zero failure rate, yet condoms, with their 98% rate of effectiveness, are held to the highest standard and get by far the worst rap.  Notice how we never see "Chemotherapy:  Not 100% Effective" or "Prayer:  Not 100% Effective"?

Amid the shame, secrecy, and slander surrounding condoms, thousands of lives are still being ruined each year by unintended pregnancies in tragic and needless accidents that could have been prevented by a 25-cent piece of latex.  I expect that someday I'll get around to making the choice to have a child, and when I do, I will love that child enough not to value an arbitrary standard of morality over his or her safety.  My kid will get a big gift-wrapped box of condoms on its 16th birthday.

The Shutdown Gets Shut Down

Last week, an epic struggle over abortion rights was waged on the Senate floor, the most dramatic such debate in at least two weeks and the likes of which will only be seen five or six more times before the end of 2011.  With just an hour to go until complete and total anarchy (in the way of closed post offices and a parking free-for-all), the government shutdown was halted when the Republicans conceded defeat in their Game of Chicken and generously agreed to devote 0.008% of the federal budget to Planned Parenthood.

http://thefeministgriote.com/?p=775

Here are just a few things that we learned in the week leading up to the Shutdown:

• "Big Abortion" is something we should be worried about.
• Abortion constitutes over 90% of Planned Parenthood's services.
• You can get a mammogram and a Pap Smear at Walgreens.

http://www.newshounds.us/2011/04/12/brian_kilmeades_misogynistic_mocking_of_planned_parenthood.php

Now, while it is evidently permissible in political discourse to use absolutely any fabricated fact or preferably a bullshitted statistic to support your argument, it still remains the case that abortions constitute only 3% of Planned Parenthood's services, and Section 1008 of Title X already prohibits these abortions from being funded by federal dollars.  Yet, in just the same way that all women entering a PP facility for any reason are harassed indiscriminately, so too were the 97% of PP services that are not abortion-related to be defunded in the right's war of attrition on abortion and women's health.

This all leaves me utterly baffled as to what's truly at the root of the debate, because its clearly not the deficit.  I do, however, have my pet theories.  First:  America's religious, corn-fed middle and lower classes care more about fetuses than about women, to put it simply.  Babies have the fortune of being cute and innocent, whereas women have had sufficient time to fuck up in some aspect of life.  I can't tell you how many times I've come across this viewpoint just in perusing other Blogspot blogs and Facebook pages:  babies are sweet, innocent, and "gifts from God," and women who are not interested in producing more of them are whores, murderers, or both.

Second: America is viscerally afraid of and opposed to sex.  We are dedicated to denying that sexuality is a natural and universal aspect of life, whether we are married or single, straight or gay, trying to procreate or not.  Women's health services pertain to STDs, pregnancy, and the general state of having genitals - all of which are matters relate to sex.  Thus, Planned Parenthood falls into the category of "things your parents get awkwardly silent about and hope you don't notice," along with condom commercials and softcore porn mags.  So why devote funds to preventing the byproducts of sex - STDs, pregnancy, and cervical cancer - when these things only happen to bad people who are just getting what they deserve?

Luckily, the joke is on detractors of women's health, because donations to Planned Parenthood have increased 500% since the funding debate first began.  Evidently, there are people other than myself who feel that saving money by not providing condoms to low-income populations may not be the best cost-reduction approach in the long run.

A Call to Arms (and to Scalpels)

Three cheers for America's judicial system.  It may be the least-appreciated branch, the "Holy Spirit" of the federal government, so to speak, but for almost 40 years now it has firmly upheld Roe v. Wade against countless legal attacks to repeal and undermine it.  In the past few decades, however, slander, intimidation, and yes, even pro-life terrorism have been much more successful than legislative initiatives at chipping away at the right to choose. The pro-life side has managed, through numerous back-door approaches, to make obtaining an abortion difficult and humiliating, if still technically legal.  Today, the biggest threat to abortion rights in the US is not the legality of the procedure, but rather the logistical access to abortion services, due in large part to the near crisis-level shortage of practicing abortion providers in the US.

Abortion remains one of the most commonly-performed procedures in America, and is certainly one of the most often discussed.  Therefore, it probably surprises most people to learn that physicians who perform abortions (or "abortionists," as they are so often called) are few and far between.  As in "entire states of separation" far between.  If you need an abortion and live in Wyoming, Missouri, Mississippi, or, God forbid, Hawaii, you are shit out of luck:  these four states lack a single abortion provider.  Even in states with relatively progressive abortion laws access to abortion is hindered merely by the scarcity of providers.  In fact, the 1.21 million abortions performed in 2008 were provided by just 1,793 facilities, with half of these services provided by just 2% of OB-GYNs.  In contrast, the nation is blanketed by well over 4,000 crisis pregnancy centers.

http://www.catholicvoteaction.org/americanpapist/index.php?tag=pro-life

It's not difficult to imagine why so few physicians provide abortions.  Clinic bombings, "abortion hit lists," Bill O'Reilly's abortion witch-hunt, and the 2009 assassination of Dr. George Tiller have all achieved their intended effect:  terrifying physicians out of providing a legal and judicially-protected procedure.  There are additional factors at play as well.  Catholic hospitals, which employ around 16% of American doctors, prohibit their employees from performing abortions even to correct an ectopic pregnancy or other life-threatening complication.  Many OB-GYNs aren't even trained in the procedure, as fewer than half of residency programs require this training.  And even physicians who identify as pro-choice may be reluctant to perform abortions due to societal pressures and the awkwardness of rarely being able to discuss their work in polite conversation.

http://worstgenerationseed.blogspot.com/2009/03/truth-truck-meets-tiller-killer.html

As a very pro-choice pre-med, these matters have been on my mind for some time now.  The nation needs abortion providers.  Women need abortions, and they will not stop needing (and procuring) them just because their doctors are incompetent or untrained.  I will someday need a specialty, and I believe in providing a service that millions of women want and need.  Of course, now is not the time to commit to a career:  even by the most optimistic estimates, it will be more than five years before I have my MD.  And regardless of how passionate I am about the cause, I'm not sure whether I'm prepared for a career that will spell a lifetime of harassment, fear, disdain, and maybe even a bullet to the head.  But it's something to consider.

http://www.theologyonline.com/forums/showthread.php?t=66908&page=2

The Rosaries in the Ovaries

In spite of the Catholic Church's continued and unwavering stance against birth control, it turns out that most American Catholics are, not surprisingly, hypocrites.  According to the National Survey of Family Growth, about 98% have used a form of contraception banned by the Vatican at some point in their lives, and 40% identify as pro-choice.  No word yet on whether these sins come up during Confession.

http://puzzledponderer.wordpress.com/2010/04/28/most-ridiculous-catholic-clothing-ever/

Yet in the developing world, particularly in Latin America and Africa, the Pope's anti-birth control, anti-condom opinions are taken more seriously.  In Catholic nations such as the DR Congo, Peru, and Haiti, rates of birth control use are negligible, and are inversely correlated with rates of HIV infection and unwanted pregnancy.  In Kenya, there have even been widely-reported instances of condom-burnings at the behest of Catholic bishops.

Now, even Pope Paul VI, composer of the treatise Humanae Vitae, acknowledged that couples might "decide not to have additional children" after giving due consideration to "physical, economic, psychological, and social conditions."  And so, to "keep up with the times," ta-da! - thus was born the Catholic institution of Natural Family Planning.  NFP is a complicated system of tracking fertility by taking one's temperature, recording daily levels of cervical mucus secretions, and filling out charts.  This enables a Catholic couple to attempt to avoid pregnancy by abstaining from sex on likely fertile days, while not "perverting the purpose of the marital act."

http://www.learkentfool.com/?p=1678

First, let's be honest:  NFP is birth control.  It's just complicated and ineffective birth control.  Second, Catholicism seems to be very arbitrary with its endorsement of all things "natural:" naturalness is something to be embraced in contraception, but to be shunned when keeping PVS patients alive for decades via ventilators and feeding tubes.

Third, I don't see how this birth control method stands up even to Catholic logic.  The line of reasoning seems to go:  "Sex that isn't open to procreation is wrong.  If I use a condom then God will be displeased, because I'm trying to prevent pregnancy.  But if I have sex according to an intricately-designed calendar, God won't be able to see through my intention.  God wants me to have babies whenever he chooses.  God can do anything.  But he can't surmount a latex barrier even when he really, really wants to."

http://babymakingmachine.blogspot.com/2009/04/natural-family-planning-techinique.html

Sure gets me all hot and bothered.

Anyway.  Couples hoping to marry in a Catholic church are now required to attend four-month classes in Natural Family Planning, to learn the ins and outs of cervical mucus charting and the evils of secular methods of birth control.  For those unable to attend a class, the marriage requirement can be fulfilled with a "home study" class for just $161.  Nevertheless, NFP use is not very common in the developed world, even among Catholic women.  In fact, only about 3.6% of Catholics practice NFP.  Still, for the very high and holy, Natural Family Planning is the one and only way to go.

Given that the Catholic stance against birth control is so often criticized for the plight of starving, HIV-ravaged third world countries, I was curious to see whether NFP had made its way to Latin America and Africa.  Surely, since the Church acknowledges that everyone might not want to procreate constantly, and since it is so concerned with preserving human life, it would try to promote its one approved method of birth control in the third world.  I discovered, however, that NFP courses are available - in English and Spanish only - in all of fifteen nations worldwide.  The majority of these nations (the US, Canada, Great Britain, Ireland, Argentina, Spain, South Africa, and inexplicably, China) are already highly developed.  NFP classes are taught in just six countries total in Africa and Latin America.  Furthermore, according to Natural Family Planning International, current efforts are focused on bringing NFP to the Czech Republic, a country with a fertility rate of 1.24 births per woman, whose people have suffered from "secularism and immorality."  In third-world majority Catholic nations, however, I suppose that the "suffering" has not been so great.

One rare instance I could find of Catholics promoting NFP in the third world comes from my very own Jesuit Georgetown.  A cohort of Jesuits affiliated with the Institute for Reproductive Health is attempting to dispense "cycle beads," rosaries for counting days of the menstrual cycle instead of Hail Marys, in Rwanda, Guatamala, and the DR Congo.  The sad fact is, though, that in the DR Congo, the so-called "rape capital of the world," where girls are often married off at puberty, even a woman's husband is unlikely to respect her wishes to abstain from intercourse during a fertile period.

If Catholic couples truly want to practice Natural Family Planning, then of course that is their right and their choice.  What I'd like to see, however, is some admission that this form of birth control is an elitist luxury, akin to buying organic food or running in Nike Nakeds.  For reasons logistical, economic, and societal, NFP is available almost exclusively in the developed world, while those without easy access are still told that condoms and other forms of "artificial" contraception will drag them down into the depths of Hell.  Yet even faced with these criticisms, the Vatican is as determined as ever not to waver in its resolve.  Pope Benedict XVI, speaking in 2008 on the 40th anniversary of Humanae Vitae, firmly supported his predecessor's treatise, and reminded the world's one billion Catholics that the Church's stance against birth control is "so crucial for humanity's future."

And I would have to agree with him there.