The body politic

The recent increase in legislation to restrict access to abortion and contraception sent us looking for an expert about this decades-long controversy. Carole Joffe is a professor emerita of sociology at UC Davis who has specialized in studying abortion-rights and reproductive-health issues. She’s written several books on the topic, including her most recent, Dispatches From the Abortion Wars: The Costs of Fanaticism to Doctors, Patients and the Rest of Us.

Why are abortion and contraception still such hot-button topics?

That is the question, and it is very puzzling. Certainly, the 2010 election was all about the economy, but we’ve seen state after state enacting abortion legislation; we’ve seen Congress introducing and spending time on all sorts of restrictions on reproductive health care; we’ve seen the rise of this “war on women.”

One answer is that it works politically. Most Americans don’t agree, certainly, with the war on contraception, and even those who don’t approve personally of abortion don’t want it to be illegal, so the question is, why is it still such an issue? Contraception has been used by more than 98 percent of American women. It’s normal and accepted. So the question really is, why would opposing abortion and contraception be a successful political strategy?

A lot of the answer has to do with voting patterns. We are a low-voter-turnout country. In presidential elections, it’s considered a good year if we get around 60 percent of voters to turn out. It’s even lower in nonpresidential years. But the people who oppose abortion—including the ultra-extreme anti-abortion people who also oppose contraception—are very, very committed and motivated. They always vote.

So that means that the people who will always vote are the people who care very deeply about these issues. To be a successful Republican these days, you must not only be anti-abortion, you must be extremely anti-abortion. Every vote you make will be scrutinized by anti-abortion groups and grade, and that information will be passed along to these committed voters.

Being in favor of contraception used to be considered very safe middle ground, and now if you don’t vote against it as a Republican, you’ll be challenged from the right in primaries by these committed voters.

Most people are in favor of contraception. This “war on women,” the move to diminish access to contraception, has women just appalled; look at the women legislators in Michigan who are being silenced for saying “vagina.”

This gets people—the political class, politicians and pundits—excited about the electoral “gender gap,” but it remains to be seen how much of an effect it will actually have. The people who support access to contraception are not as intensely focused on this one issue as the opponents of contraception are; we need to remember that there are voters on the GOP side who only vote based on the candidate’s opposition to abortion and contraception.

Overall, this is not a very political country. It’s a very polarized country, but most people don’t follow these issues very closely. Even though they’ll vote, contraception and abortion will not be their main driving issue. And when you’ve only got one-half to two-thirds of the country voting, and most of them are voting on issues other than contraception and abortion, then a lot of people who do not reflect the country’s position on those issues as a whole are going to be elected.

In Arizona, they passed a law that says if you have an ultrasound and if there are abnormalities, the doctor does not have to tell you if he or she thinks you might choose to have an abortion. You can’t sue them later for not telling you. So we’ve got a situation right now where legislatures are passing laws telling doctors to lie to their patients on this issue, with no consequences.

How can these politicians get away with it? Because it will get them votes from that group of people who actually vote.

The other thing is that discussions abortion and contraception make people very uncomfortable. Compared to other industrialized Western nations, we’re very uncomfortable with talking about sex; we don’t have very good sex education in the [United States], and it leaves us at a loss when we should be discussing these issues sensibly. After all, we live in a country where elected legislators can be silenced for saying “vagina”!

How did we get to a place where contraception is up for debate?

It was the result of a very determined campaign, starting with emergency contraception. That term is used to refer to what some people call the morning-after pill. For a long time, the understanding in the medical community has been that emergency contraception prevents ovulation, but it’s hard to prove a negative, so scientists couldn’t completely rule out that it prevented implantation. That meant that the possibility of preventing implantation was included in the labeling, and so this allowed many people in the anti-abortion camp to say, “Oh, it’s an abortifacient.”

Now, of course, there is far more certainty that this is not the case, and the [U.S. Food and Drug Administration’s] labeling has finally been changed, but this history as been confusing and has allowed the envelope to be pushed farther and farther in the war against contraception.

The anti-abortion movement has reframed the debate in such a way that they’re debating what actually constitutes being pregnant. It seems pretty silly—most people would say you’re either pregnant or you’re not—but it’s become rather murky in this debate.

The medical position is that pregnancy begins at implantation. The anti-abortion movement has assiduously moved to reframe the discussion and claim that pregnancy starts the minute a sperm meets an egg.

So, we had several things coming together. We had fights over emergency contraception, caused by some confusion—not necessarily for political reasons—between the emergency-contraception pill and the French abortion pill RU-486, which both entered the [United States] at roughly the same time. Medical professionals knew about E.C. for years; women who needed emergency contraception were just given high doses of contraception. But in many people’s minds, E.C. and abortion pills became confused.

And then there’s this orchestrated confusion about when pregnancy begins. And then there’s the growing influence of the religious right.

Starting with E.C., we also had the phenomenon of pharmacist refusal, which is that some pharmacists started refusing on religious or conscience grounds to dispense emergency contraception. Now, there’s almost no borders anymore as to what health-care professionals feel they have a right to refuse. Some pharmacists are on record as refusing to refill regular birth-control pills. Some ambulance drivers have refused to transport women to hospitals if it involves a need for an emergency abortion. Some clinicians refuse to provide assisted reproductive services, such as for gay couples. We are having an interesting conflict in our society between the individual’s right to “my conscience” and the right of women to receive appropriate medical care.

And we can’t talk about this present moment without also factoring in the enormous opposition to [President Barack] Obama in particular and to health-care reform, the Affordable Care Act, in general.

My book did predict this: I knew that abortion and contraception would be stumbling blocks to health-care reform, but I didn’t anticipate how close it would come to derailing the whole thing, and continue to be an enormous problem.

So we've got built in problems, like American's discomfort with talking about abortion and contraception, on top of political opposition.

And the reframing of the provision of these services as an attack on religious liberty. The Obama administration is saying that under the Affordable Care Act, insurance providers should pay for a certain number of prevention services: mammograms, cancer screenings and so on. And contraception is, by definition, also a prevention service: It prevents unwanted pregnancies. There seemed to be a compromise between the Obama administration and Catholic institutions about providing contraceptive services to their employees, but now it has broken down, even though the administration took steps to make sure that these Catholic employers would not be directly paying for those services. And it’s important to remember that many of those who work at Catholic-affiliated institutions, such as hospitals and schools, are not themselves Catholic. And Catholic women, as it happens, use birth control to the same degree other Americans do.

So, religious institutions are saying they should not be coerced to violate their conscience, even though they’re not paying for it. And the conflict is thus set. We as a society are having to re-examine such tough questions as what religious freedom means, what religious tolerance means in a diverse society.

How can we keep our reproductive rights—including the right to carry unplanned pregnancies to term if we choose?

I have another V-word for you, and that’s vote. That’s the main thing that can be done. In the Bay Area, the legislators are very pro-choice, and California is a very pro-choice state, but some of your readers live in areas with Republican representatives who have very conservative records on these issues.

I’d point to [House Resolution 358], which was introduced in January 2011, the so-called Protect Life Act. This was among the first pieces of legislation introduced in the new Republican congress of 2011, and it said that hospitals are not compelled to offer an abortion to a women in a life-threatening situation. The legislators who voted for it are on record as saying “We don’t care if women die.” I suggest that women—and the men who love them—go to the congressmen and women who voted for this act and say, “Do you want me or my wife or my daughter to die because of this bill? Would you want you wife, mother, daughter or mine to die because of this?”

The “new normal” is that it’s become OK to vote for something that will let women die. My advice is to hold them accountable.