Head silently exploding

I have had more than one person ask me what I thought of the recent proprosed rule from the Department of Health and Human Services.

Trust me, I have been following the story. Many of the blogs I subscribe to have been addressing it: feministing (they get the best photo accompaniment award), feministe, women’s health news, and RH reality check. Many of these sites have more than one post on the subject, and many have excellent link lists of other posts or news articles on the subject.

I have actually been silently seething about this for quite a while. I forget where I heard or read about the head of the HHS family planning department, Dr. Susan Orr, stepping down to supposedly distance herself from this nonsense. In fact, I wrote about it in this post which was an assignment I turned in for my Culture and Health Class. When I heard she was stepping down, the report proposed a connection to a rumored new rule from the department that clearly came straight from her radically anti-reproductive choice group, the Family Research Council, one she apparently wanted to distance herself from when it hit the fan, so to speak.

But, I came back from vacation with less than six hours to spare before my first day of class, and we will be taking our second test in two weeks Monday morning. So, please forgive me for letting this one brew a bit. I have been rather afraid to touch it, since I have so much to say and so little time and emotion to spare on it. And the emotion is there, trust me. This gets me angry to the pit of my stomach.

This proposal has some very clear, unabashed goals. First of all, it intends to deny women health services. Instead of working to improve access to birth control and family planning services for women, it wants to find new and creative ways to deny health care based on a narrow, minority view of women’s health. The federally funded programs they are targeting will include every public clinic that serves underserved women. The very same clinics that distribute birth control to the vast amounts of women who couldn’t afford it otherwise. It would also affect a significant number of not for profit and private clinics that also choose to serve underserved populations, including Planned Parenthood, clinics at universities, and other independently run, but subsidized centers. In fact, I could easily see how it could extend to any clinic that accepts Medicaid, Medicare, or sesrves members of the U.S. Military. This has nothing to do with a private practitioner in a private offices making decisions about what practices she feels comfortable performing.

Secondly, it seeks to riddle federally funded health care sites with activists who subscribe to this narrow, non medically based world view. There are a lot of very pressing issues that the HHS could be dealing with right now. If you want a list, check out Healthy People 2010. I don’t see "allowing more fringe religious activists to deny health care to the underserved" on any of their lists of recommendations. It is not the role of the U.S. Government to protect the so called "right" of every political extremist to influence the way public policy is carried out. If the Family Research Council wants to make sure that people who are against reproductive rights are employed in this field, paid by federal grants, and then protected from discipline as they block the efforts to deliver reproductive health care, then they need to be funding legal campaigns. Why the HELL is the Department of Health and Human Services (and our tax dollars!) doing their dirty work?

Finally, about the definition. After some not very convincing background research, the rule proposes two dramatic definitions that would rock the medicoethical world if they became law. One would be to define pregnancy as begin at the fertilization of the egg. Not only does this not agree with the definitions put forth by major medical groups like the AMA, AOA, ACOG or ACOOG, but it is a ridiculous definition, medically. That is not a measurable point, first of all. Implantation has biochemical markers. One of the reasons there are biochemcal markers is that the blastosphere makes contact with the woman’s body again. When the egg is released, it is released. We may not think of it as such, but many of our bodies various tubes contain areas that are NOT physiologically our body. Our GI tract, first of all, has a mucosal barrier. We choose what we absorb, and the rest never enters us physiologically. Same thing in the kidneys – we excrete in the kidney, not from the urethral hole. Once urine becomes urine, it is not us anymore.

Menstrual blood is not us. A floating egg, fertilized or not, may reattach to us, or it may float on out. Women who do not take birth control, whether it is their choice or because right wing activists have fought tooth and nail to deny it to them, will be passing a lot more of these poor little blastospheres than women who are on birth control. My reproductive physiology teacher estimated that less than 10% of fertilized eggs implant. I have read many other statistics that say 30% of these implanted eggs will be a spontaneous miscarriage during the first trimester. I would think most women would want more research on miscarriage than the eggs that pass through without symptoms of cramping and heavy bleeding, especially women who are habitual aborters and desperately would want to stay pregnant.

It would seem to me that this focus on passed eggs is like focusing research on infectious disease on the bugs that aren’t virulent and don’t infect us.  No one cares about the E. coli that doesn’t get us sick, and there is plenty of that about. It’s the type that does physiologically affect us that I would hope the CDC will be researching and tracking.

This definition is specifically intended to throw suspicion on the major forms of birth control. Although no major medical organization, and not even <a href="http://web.archive.org/web/20070814095925/http://www.epm.org/articles/doctors.html">physicians who are against abortion</a> agree that the pill or the IUD are abortifacients, the radical anti-choice has fought to confuse the discussion on this.

One self-identified "pro-life" physician writes:

"One may get an idea of the frequency of conception on hormonal contraceptives by considering the ectopic (tubal) pregnancy rates. The ectopic rate in the USA is about 1% of all pregnancies. Since an ectopic pregnancy involves a preimplantation blastocyst, both the "on pill conception" and normal "non pill conception" ectopic rate should be the same- about l% (unaffected by whether the endometrium is "hostile" or "friendly.") Ectopic pregnancies in women on hormonal contraception (except for the minipill) are practically unreported. This would suggest conception on these agents is quite rare. If there are millions of "on-pill conceptions" yearly, producing millions of abortions, (as some "BC pill is abortifacient" groups allege), we would expect to see a huge increase in ectopics in women on hormonal birth control. We don’t. Rather, as noted above, this is a rare occurrence. "

So, using an incorrect definition of pregnancy and then encouraging incorrect discussion of the physiology of birth control is another clear yet unspoken goal of this rule.

Finally, the rule seeks to define the fertilized egg as a "human being". This is a very troubling definition ethically. Please note the statistics above about theoretical implantation rates of these so-called beings. How about those thousands of frozen embryos, in limbo in fertility labs across the country? How about physicians that do choose to do surgical abortions – of unwanted embryos, of molar pregnancies, of anencephalic fetuses. Are they murdering human beings? Really? Performing the most common surgery in the country? 30 to 40% of women of childbearing age, according to the Guttmacher institute, will ask her doctor to murder a "human being"? The Lancet, in its special issue on global women’s health, asked for more access to human being murder to save women’s lives? No, it didn’t, and this kind of ridiculous inflammatory language makes me sick. And, any adopted legislation, especially authored by the HHS, would be a precedent for incremental laws restricting access to birth control, emergency contraception and terminations.

The only silver lining I can see in this is that I have to do a speech in a few weeks to recruit the first year students to Medical Students for Choice. This should help. I hope it also helps light a fire under every woman who thinks that Republicans and Democrats are the same on Reproductive Rights.