Willing and Unable: Doctors' Constraints in Abortion Care

Notes

159 notes Notes to Chapter 1 1. All names of individuals interviewed for this book are pseudonyms in order to protect the confidentiality of the study participants. 2. On January 22, 1973, the Supreme Court legalized abortion with its decision in Roe v. Wade. Women thereafter had the right to terminate a pregnancy up to the gestational point of viability (when a fetus can survive outside the womb with medical assistance), which was considered to be about twenty-eight weeks’ gestation at the time of the decision, but with medical advances is currently closer to twenty-four weeks. (For an accessible overview about medical understandings of fetal viability see Krissi Danielsson, “Premature Birth and Viability,” About.com, miscarriage.about.com/od/pregnancyafterloss/a/prematurebirth.htm.) In the Roe decision, abortion rights during the first trimester of pregnancy were granted nationally , although some states had already begun to change their laws. An online resource for Supreme Court cases summarized the case thus: “The Court held that a woman’s right to an abortion fell within the right to privacy (recognized in Griswold v. Connecticut) protected by the Fourteenth Amendment. The decision gave a woman total autonomy over the pregnancy during the first trimester and defined different levels of state interest for the second and third trimesters. As a result, the laws of 46 states were affected by the Court’s ruling” (Oyez, U.S. Supreme Court Media, www.oyez.org/cases/1970-1979/1971/1971_70_18/). 3. An elective abortion stands in contrast to an abortion that is done for medical reasons—because the fetus is not healthy or the woman’s health is endangered by the pregnancy. Physicians I spoke with differentiated these two groups of abortions regularly, and elective abortions are often perceived as more political and less legitimate than those they refer to as “genetic” or “maternal health” terminations. These distinctions are socially constructed, of course. A woman may elect to terminate or not terminate any pregnancy, whether she or the fetus is healthy or not. And women who are raped or experiencing severe poverty or abuse may feel they have no choice but to “elect” abortion. However, for the 160 notes to pages 4–9 purposes of communicating the concepts of abortion known to physicians, elective abortions here specifically refer to those procedures without a medical diagnosis of maternal or fetal health problems. Perhaps because of abortion stigma and the desire of many people not to say the word abortion, there are many different terms and abbreviations commonly used instead of abortion, even when such differentiation is not medically necessary : evacuation of the uterus, or uterine evacuation; termination, or pregnancy termination; AB (abortion); TAB (therapeutic abortion); VIP (voluntary interruption of pregnancy); TOP (termination of pregnancy); and missed AB (miscarriage ). See also Appendix A. 4. This is based on a comparison of data available on the incidence of medical procedures nationally. Owings and Kozak (1998) provide the most recent presentation of all hospital and ambulatory procedures together but eliminate abortion clinics from their data sources. They reported that for women of reproductive age in 1996 the most common procedures were birth related; number one was episiotomy, at 1.29 million. In 1996, abortion was the most common procedure, at 1.36 million. In the 2005 National Hospital Discharge Survey, DeFrances and Hall (2007) showed that the number of episiotomies had gone down dramatically to 537,000, but cesarean sections had risen to 1.29 million. For comparison, Jones et al. (2008) showed that abortion declined to 1.21 million in 2005. Therefore , in 2005 the abortion rate dipped below the caesarean section rate. Jones et al. (2008) attribute the abortion decline to increased contraceptive use, lower unintended pregnancy, more women carrying unintended pregnancies to term, and decreased access to abortions in certain geographical areas. 5. Laura Nader coined the expression studying up in her analysis of power dynamics between the researcher and the researched. She challenged social scientists to find out more about the social world of the powerful, despite the fact that they are able to insulate themselves from outside examination more easily than groups with less power. 6. When using the term pro-choice in regard to a person, I specifically mean someone who supports the legal right of a woman to have an abortion if she chooses. I often use the term abortion rights advocate or activist to signify people who devote significant energy toward ensuring reproductive rights, access, and quality of care, beyond the basic...