It has been quite a whirlwind of a week in the women's health community, hasn't it? Two major women's health organizations, Susan G. Komen for the Cure and Planned Parenthood, battled for women's respect and donations. Two days later the dust is settling and we're left to wonder what we should take away from the tangle?
Was it about fundraising? Women's health? Politics? I suggest it is about stigma, specifically abortion stigma that has been deliberately attached to a beloved national institution and household name, Planned Parenthood.
Despite data stating that only three percent of the services provided by Planned Parenthood across the country are abortion procedures (compared with 16 percent devoted to cancer screening or 35 percent to contraception), conservatives have succeeded in making Planned Parenthood synonymous with abortion. And abortion stigma is contagious. It makes groups like Komen want to disassociate themselves from it and to leave Planned Parenthood alone in its quarantine. At Ipas, a group working only on the issue of abortion, we know a little something about stigma. It begins with identifying and isolating the stigmatizing condition.
It is well known that ever since Roe v Wade was decided in 1973, forces opposing abortion galvanized and have worked steadily and relentlessly to take away a woman's most fundamental right to freely decide whether and when to bear a child. Just months after the historic Supreme Court decision, the Foreign Affairs Act was amended to restrict any U.S. foreign assistance funds from being used to support safe abortion care -- even though unsafe abortion was then and continues to be a leading cause of maternal deaths in developing countries. But poor women in developing countries are an easy target. They don't vote in the United States, and they certainly don't donate to political campaigns. But what became known as the Helms Amendment legitimized the belief that we can cut off abortion from the rest of a woman's health care.
In 1976, a similar restriction was imposed on poor women in the United States. Women with private health insurance can avail themselves of their legal right to abortion. But because of the Hyde Amendment, women on Medicaid may not - even though we know that terminating an unwanted pregnancy is safer, and certainly less expensive, than carrying to term. But Helms already established a precedent, and while poor women may vote, they do so at lower rates than motivated anti-abortion ideologues, and they certainly don't donate to political campaigns. Now we see abortion cut off from women's health here in the United States.
Over the next 40 years, incremental efforts to carve out additional exceptions to Roe have succeeded in isolating abortion both politically and practically: In addition to parental consent laws (and the current trend: forced ultrasound and mandated counseling), abortion is often only performed in designated health care facilities (like Planned Parenthood clinics); medical schools are not even obliged to teach the procedure, for fear of offending those with "conscientious objections;" and federal and some state employee health plans are barred from covering abortion care.
But abortion opponents have perhaps had their greatest success in their efforts to silence and shame anyone or any group that dares to continue any sort of relationship with abortion rights advocates or providers. Their pressure is relentless and comes in many forms -- from the high level political pressure that Planned Parenthood has experienced from Congress during the past two years, to the discomfort that we all feel when electricians or printing companies -- or even other health-care organizations -- refuse to work with us.
And, really, how can we expect organizations like Komen to stand up for all women's health needs when even the most powerful nation in the world cannot cope with the fact that women wish to terminate pregnancies? Under this pro-choice president, not only do restrictive policies like Hyde and Helms remain in place, President Obama is clearly challenged to even utter support for a woman's right to abortion.
A question I am left with is whether the outcry would have been as swift and powerful if Komen had simply announced that they were ending support for any and all women's health programs where abortions were performed instead of targeting an important national symbol like Planned Parenthood. Would so many individuals -- 'Racers for the Cure' and celebrities alike -- rise up in protest? My guess is no, they would not -- and this is the power of the stigma around abortion.
When access to health care is limited by money or geography, we cannot afford to limit it further with politics. Yet we see it happen again and again when it comes to women's health. Given the success of the political attacks on contraceptive and abortion care in general, and Planned Parenthood in particular, you can see how Komen thought they could score an easy political win and placate abortion opponents by throwing Planned Parenthood under the bus. The abortion stigma card can be played at any time to scare off opposition.
The good news is that in this case, opponents to abortion overreached, and Komen's attempt to demean and isolate abortion providers backfired by alienating their own supporters. However, that doesn't change the game. When we acknowledge that abortion is a part of comprehensive health care - just as breast exams and pap smears are - then we will be able to move the goal posts.