TESTIMONY TO THE SOUTH DAKOTA TASK FORCE TO STUDY ABORTION
Lynn M. Paltrow, J.D.
Executive Director of National Advocates for Pregnant Women
September 22, 20051
Madame Chairwoman and Members of the Task Force: Thank you for this opportunity to present to you today. My name is Lynn Paltrow. I am an attorney and Executive Director of National Advocates for Pregnant Women, an organization devoted to protecting the interests of pregnant and parenting women and their families. In addition to litigation and policy analysis, I am author and co-author of numerous commentaries and articles including ones published in medical journals such as the American Journal of Obstetrics and Gynecology and the Journal of the American Medical Association 2. I am also a frequent lecturer to medical and public health organizations and to health care providers 3. In addition, I have served on both state and federal panels concerning pregnant and parenting women 4.Many of the cases that I have worked on involve women who have wanted to continue their pregnancies to term and many of these women oppose abortion.
I have been asked by this Task Force to provide "An analysis from both the legalistic perspective and from the psychological perspective of the degree to which the decision to undergo an abortion is actually voluntary and the degree to which such abortion constitutes an appropriate legal waiver or termination of the relationship between the woman and the unborn child."5
I want to begin by being clear about the women who are the subjects of this Task Force's inquiries. More than half of all women having abortions already are mothers 6, raising one or more children 7. A majority of those having abortions that are not yet raising children, will someday become mothers and spend much of their lives raising and caring for their children and other loved ones. As a result, the questions addressed by this Task Force concern mothers and pregnant women. These are the women that I will be talking about today.
As an attorney, I will be focusing on legal questions especially on the meaning of the term "voluntary." I will also address whether pregnancy should be viewed as some kind of contractual relationship between two wholly independent parties - pregnant woman and fetus. In order to explore these questions I will provide case examples that demonstrate what happens when pregnant women and fetuses are treated as separate and competing legal entities as well as cases where women's reproductive and health decisions have unquestionably not been voluntary.
The meaning of "involuntary"
I begin with the case of Angela Carder: Angela Carder at 27 years old and 25 weeks pregnant became critically ill. She, her husband, and her parents as well as her attending physicians all agreed on treatment designed to keep her alive for as long as possible. The hospital, however, called an emergency hearing to determine the rights of the fetus. A lawyer appointed for the fetus used the anti-abortion argument that fetuses are separate legal persons with independent rights. This lawyer argued that the fetus had a right to life and that what Angela Carder, her husband, and her family wanted did not matter. Despite testimony that a cesarean section could kill Ms. Carder, the court ordered the surgery, finding that the fetus's rights were controlling. The surgery was performed over her explicit objections and resulted in the death of both Angela and her fetus. The fetus, or as in Angela's parents words - their "unborn grandchild" - died within two hours and Ms. Carder died two days later with the c-section listed as a contributing factor 8.
According to the Webster's Third New International Dictionary at 2564 (1981) Voluntary means: "1(a): proceeding from the will: produced in or by an act of choice, (b): performed made, or given of one's own free will, (c): ready, willing, (d): done by design or intention: not accidental: intentional, intended." Clearly the surgery Ms. Carder was forced to have in the name of fetal rights - that ended both her pregnancy and her life - were not voluntary.
Unlike Ms. Carder, Ayesha Madyun survived. She too, however, was forced to have a c-section based on the claim that her fetus had independent rights greater than hers. Ms. Madyun had been in labor for more than 30 hours and as a result, her doctors believed that her baby was at risk of dying from an infection. Her request to be allowed to wait longer before having a cesarean section so she could try natural delivery was portrayed to the court as an irrational religious objection to surgery. The court granted the order. After Ms. Madyun had been subjected to surgery without her consent and forcibly cut open, the doctors found that there was in fact no infection. 9
The forced surgery that Ms. Madyun endured in the name of fetal rights was not voluntary. In Illinois, another hospital also using anti-abortion arguments claiming the existence of separate legal rights for fetuses, obtained a court order permitting it to force a pregnant woman to undergo a blood transfusion. Doctors "yelled at and forcibly restrained, overpowered and sedated" the woman, in order to carry out the order. 10This blood transfusion was not voluntary.
Although appellate courts and leading medical organizations have now overwhelmingly rejected these forced interventions, these cases provide key examples of what "involuntary" means in the context of pregnancy and what has and will happen if pregnant women and fetuses are viewed as having independent legal rights. 11
A more recent case provides another disturbing example. In January 2004, Pennsylvania resident Amber Marlowe went to the hospital to deliver her seventh baby. She and her husband describe themselves as true believers in the Bible and they deeply oppose abortion. For medical reasons far from compelling, the hospital believed that Mrs. Marlow needed to have a c-section. Neither Mrs. nor Mr. Marlowe had any religious objection to surgery. Both felt however that after six other deliveries Ms. Marlowe knew her own body well enough to know that this delivery was possible without surgery. In addition, the Marlowes did not want to subject either Amber or her unborn child to unnecessary surgery that would increase risks to both, and that would unnecessarily prolong the mother's period of recovery (something that this primary caretaker of six and soon to be seven children wanted to avoid). Rather than respect her informed decision, the hospital sought and obtained a court order giving the hospital custody of the fetus "before, during, and after delivery," as well as the right to force Ms. Marlowe to have the C-section. The hospital used anti abortion legal arguments asserting the independent legal rights of the fetus. 12 Mr. and Mrs. Marlowe left the hospital before the order could be executed. Mrs. Marlowe gave birth to a healthy baby through vaginal delivery. 13
Mrs. Marlowe avoided involuntary surgery. Nevertheless, this case presents another clear example of action that would prevent voluntary medical decision-making. The hospital sought and obtained an order "permitting [the hospital] to perform a C-section delivery of Baby Doe without the consent of the Doe parents." 14
There are other very clear examples of what "involuntary" means. Over the course of American history, for example, thousands of white American women, 15 Native American, 16 Latina, and African American women were sterilized against their wills, without consent, or under threat. For example, in 1975 ten Chicana women sued Los Angeles County hospital and state officials for incidents of forced and coerced sterilization. One of the women had refused to giver her consent to a sterilization. She was punched in the stomach by a doctor and then sterilized.17This woman's reproductive health experience was unquestionably involuntary.
In the Relf case, two African-American teenagers in Alabama were sterilized without their consent or knowledge. A federal district court found that there was "uncontroverted evidence in the record that minors and other incompetents have been sterilized with federal funds and that an indefinite number of poor people have been improperly coerced into accepting a sterilization operation under the threat that various federally supported welfare benefits would be withdrawn unless they submitted to irreversible sterilization." 18 These reproductive health outcomes were unquestionably involuntary.
Another example of the true meaning of involuntary is reflected in the lives of African-American women who, during slavery, had no rights whatsoever regarding their reproductive lives. Sexual intercourse, marriage, childbearing, and birth were all under the control of their masters.19
These examples of forced, and involuntary treatment of women provide an important contrast to the experience women have of abortion in America today.
The meaning of voluntary
Each year approximately one million women in America have abortions. 20 There is no legal, medical, or scientific evidence that these women who have had abortions have done so involuntarily. Indeed, in today's legal and political climate we would have to conclude that the abortion decision is "super voluntary" "ultra voluntary" or "voluntary plus."
South Dakota along with virtually every other state in the union has enacted stringent laws in the name of informed consent. These laws not only impose counseling and informational requirements far beyond those required prior to other medical procedures but some of these laws also require health care providers to convey explicitly state opposition to the procedure. Since 1992 states have enacted 487 laws restricting access to abortion. 21 Many of these laws call for scripted and mandatory counseling, waiting periods, and parental notice or consent. Some additionally require abortion providers to offer women ultra-sound images before the procedure and to inform them of economic supports hypothetically available to them if they continue to term. 22
The fact that approximately one million women each year have abortions in spite of these requirements, in spite of increasing social and political pressure against abortion, and sometimes in spite of picketers, protesters, and stalkers calling them murderers, 23 should reassure this Task Force that the abortion decision is more voluntary, conscientious, and determined than many health and family related decisions in America today.
I have not been able to find any cases that found that reproductive health providers have forced or coerced abortions. In instances where there have been concerns that family or teachers have attempted to coerce an abortion, the decision in Roe v. Wade has provided pregnant woman with protections. For example, in Arnold v. Bd. of Educ. of Escambia County Ala., 880 F.2d 305, 311 (11th Cir. 1989) parents claimed that a school guidance counselor, vice-principal, and school board coerced a student into having an abortion. The court allowed a civil rights suit against the school officials to go forward. Citing none other than Roe v. Wade, the court explained that our constitutional law ensures that "the individual must be free to decide to carry a child to term." Similarly, in Planned Parenthood v. Casey, the US Supreme court noted that its decision in Roe v. Wade, 410 U.S. 113 (1973), "had been sensibly relied upon to counter" attempts to interfere with a woman's decision to become pregnant or to carry to term. Casey, 505 U.S. 833, 859 (1992).
Lacking case law examples, or peer reviewed, evidence-based research establishing that women's abortion decisions are not voluntary or informed, the analysis called for today relies on implication; the suggestion that the pregnant women and mothers of America are being tricked or manipulated. Far from reflecting involuntary, coerced or misinformed decisions, however, the real experiences of women who are the subject of today's hearings make clear that their decisions are based on profound ethical, religious, and family considerations.
Some years ago women and family members were asked to write letters describing why they or someone they knew chose to have an abortion. Not one of the people who wrote said they or a loved one had had an abortion because they were forced to do so. Instead each of the writers talked about fundamental family and religious values and their deep sense of responsibility. One woman wrote: "When I found out I was pregnant, I had my two boys to care for, and Norma, a baby girl. I already had all that I could handle, because my third child, our daughter was a spina bifida baby, and I had made a promise to myself, when she was born with this condition, that I would take care of her . . .." Another explained her decision saying, "I was a Christian then, as I am now, and constant prayer asking for guidance through peace is how I was able to feel that God guided me toward that decision, also." 24
For so many pregnant women and mothers the decision to have an abortion is not only voluntary, it is ethically mandated by obligations to self and to others.
The legal, medical, and social history of abortion confirms that the decision to end a pregnancy is "super voluntary" or "voluntary plus." Before the Supreme Court's decision in Roe v. Wade, state governments were free to substitute their political judgments for the personal, moral judgments of women and the medical judgments of doctors. Despite the laws that prohibited or restricted abortion, women made decisions about their reproductive lives and obtained the abortions they needed and wanted. 25 After abortion became illegal in the United States in the late 1800's, 26 women continued to have them, defying statutory prohibitions on abortion, 27 as well as public norms and for some, clear religious proscriptions. Estimates of illegal abortion in the United States in the 1960's ranged between 200,000 and 1,200,000 a year. 28
The fact that women had abortions in the past, despite criminalization, and continue to have abortions in America today in spite of increasing barriers to that health care service makes clear that the decision to have an abortion is a voluntary decision. 29
Finally, if this Task-Force is truly committed to the value of the lives of all pregnant women and mothers it would necessarily include within the scope of its investigation so-called crisis pregnancy centers. In contrast to the extraordinarily regulated providers of abortion services, who are required as a matter of medical ethics and law to provide accurate medical information and to obtain informed consent, crisis pregnancy centers are not similarly regulated and have repeatedly been found to provide false and misleading information to the women who seek help at those centers.30
The decision to have an abortion is still "voluntary" even when made in constrained circumstances.
This committee should not confuse the question of whether or not a decision is voluntary and informed with the different question of whether or not men and women must make important life, health, and family decisions within real-life financial, community, and personal constraints. 31
For example, if a woman chooses to have an abortion because her boyfriend beats her up when he finds out that he impregnated her, the decision to have an abortion can still be both voluntary and informed, even if made under circumstances that influence her decision and constrain unlimited choice. 32
According to the South Dakota Coalition Against Domestic Violence, in the United States, "1.3 women are raped every minute." Put differently this means that in America there are "78 rapes each hour, 1,872 rapes each day, 56,160 rapes each month and 683,280 rapes each year." Also according to SDCADV "50% of women in America will be battered in their lifetime; one out of three are battered repeatedly every year." 33 The leading cause of pregnancy related deaths in America today is murder. 34
The violence so many women in South Dakota and across America experience on a daily basis is another good example of the meaning of "involuntary." A Task Force to examine why men - who disproportionately though not exclusively - commit violence against women would reflect true valuing of mothers, pregnant women and their families and life itself.
The sad truth is that whether pro-or anti choice, the vast majority of women must make reproductive health decisions in a country that has sent a clear message: We do not value the work that you do as mothers and caretakers. America is one of only three industrialized nations in the world that does not require any paid maternity leave. 35 While holding this Task Force hearing about abortion, South Dakota has not to my knowledge explored the possibility of guaranteeing new mothers or fathers any paid parental leave. Similarly pregnant women of all political and cultural stripes are vulnerable to workplace discrimination. Between 10 and 20 million women, including those who work part-time or for small companies, are not protected from discrimination based on pregnancy. 36 Again, while this legislature has considered numerous bills over the years to restrict access to abortion, 37 no legislation to my knowledge has been introduced, much less passed, to prevent these forms of discrimination against pregnant women and mothers who must work in order to feed and house their children.
Pregnant women must also make reproductive decisions in a context in which they must worry about whether they will be able to provide for and protect the children they do have. Nearly one in five children are living in poverty. 38 In addition, America's infant mortality rates continue to exceed many third world countries. According to the CIA's World Factbook, the United States ranks 43rd in the world in infant mortality. If the United States could reach the level of Singapore, ranked first, we would save 18,900 children's lives each year. 39
Rather than yet more restrictions on abortion, South Dakota's legislature should consider how to help women to care for their families and ensure that pregnant women live in a country where they need not worry that their children will survive infancy or go without health care, food, shelter, a good education, and a safe and healthy environment.
The decision to have an abortion is still voluntary even if some women experience sadness or other feelings at some point after the procedure.
This committee must also distinguish between decisions that are voluntary and informed and the feelings people necessarily have about the decisions they have made in their lives. The fact that some women unquestionably experience severe post partum depression following child birth is something to be taken seriously, but it does not provide any basis for concluding that pregnancy and childbirth are involuntary, occurred without adequate information, or that it is now necessary - for their own protection - to require every woman seeking prenatal care to obtain a separate psychological evaluation. Similarly more than 900,000 women each year suffer miscarriages and stillbirths. 40 Many do so without meaningful support from any health care provider. 41 Some experience serious psychological distress from this experience. These facts, however, again tell us nothing about whether or not the decision to become pregnant and to try and carry to term - in spite of the risks of miscarriage and stillbirth - was involuntary or uninformed. 42
Testimony by psychologist Vincent Rue before this Task Force claims that women who have abortions are at serious risk of experiencing what he as called "post abortion trauma," a unique trauma associated with having had an abortion. Dr. Rue argued that this Task Force should adopt significant and costly new laws based on his personal theories. These theories, however, have been rejected by his peers - both in the field of psychology and among leaders opposed to abortion. Former United States Surgeon General, Dr. Koop, for example though personally opposed to abortion, has testified, "the psychological effects of abortion are miniscule from a public health perspective." 43 Moreover the assertion that there are unique and significant psychological harms as a result of abortion has been rejected by numerous peer reviewed scientific studies addressing this question 44 and by leading medical groups including the American Psychiatric Association and the American Psychological Association. 45
Having said this, it is nevertheless crucial to the lives of all pregnant women and mothers that our families and communities acknowledge that women who have abortions, like those who suffer miscarriages, and those who continue to term, and those who give up their children for adoption, 46 may experience a wide range of emotional responses. However, to use those feelings to suggest that the very deliberate, conscientious, and sometimes difficult decision to have an abortion is some how involuntary or misinformed is to express profound disregard and disrespect for the 25 million women who have made that decision.
Rather than deny women's experiences or risk misusing them to justify a political agenda, this Task Force could support Exhale - a national non-judgmental abortion talk-line that offers women as well as friends and family members a place to talk about their feelings. 47(1-866-4-EXHALE). Similarly, this Task Force could, if truly concerned with the lives and well-being of all pregnant women and mothers, endorse full parity for mental health services for everyone who needs them.
It is not possible to treat pregnant women and fetuses as competing legal entities in the context of abortion without undermining the health, wellbeing and safety of all pregnant women and new mothers.
This committee also asked me to consider "the degree to which such abortion constitutes an appropriate legal waiver or termination of the relationship between the woman and the unborn child."
If pregnancy is a "legal" "relationship," with opposing rights and the possibility of state oversight, the implications for the civil rights, health and well-being of pregnant women and their children is in serious question. Does a pregnant woman who cannot overcome her addiction to cigarettes violate this "legal" "relationship," making her an appropriate subject for court ordered treatment, arrest for child endangerment, or child welfare interventions? Does a woman lose her right to informed medical decision when she becomes pregnant? Could the state mandate that all women deliver by c-section because of perceived benefits to the unborn child? Could the state outlaw vaginal births after c-sections?
Similarly, if pregnancy is viewed as a legal relationship between completely separate parties having separate, competing rights, shouldn't every woman who has experienced a miscarriage or stillbirth be questioned about the extent to which she may have contributed to that pregnancy loss and whether those actions or omissions constituted an appropriate legal waiver?
These questions do not represent far-fetched hypothetical possibilities.
For the last 30 years anti-abortion rhetoric has portrayed abortion as murder and the women who have those abortions as "baby killers" and "murderers." Increasingly, all pregnant women are being viewed as proper subjects of the criminal law and court supervision. Pregnant women in more than 30 states including South Dakota 48 have been arrested based on the claim that a health problem, action or circumstance a woman experienced during pregnancy can be treated as child abuse of she continues to term, or murder if she suffers a miscarriage or stillbirth. Women in California, 49Florida,50 Utah,51 South Carolina, 52 Tennessee,53Oklahoma,54 and North Carolina55 have been charged with manslaughter and even first-degree murder for having suffered unintentional stillbirths. Prosecutors in these cases have argued that something they did or did not do during pregnancy caused these pregnancy losses. In some cases the pregnancy loss is blamed on an untreated drug problem, in another a severely depressed woman was arrested after an attempted suicide might have contributed to a pregnancy loss, 56and in another it was the pregnant woman's decision to delay having a c-section that transformed her into a murderer.57 Such prosecutions continue despite the lack of authorizing legislation, court rulings rejecting such misuse of state law, and in spite of the overwhelming oppositions from medical, child welfare and public health organizations. 58
Today, many pregnant women and newly delivered birth mothers also face child welfare interventions based on the claim that something they did or did not do during pregnancy constitutes child abuse or neglect. Women for example who have tested positive for illegal drugs and even for drugs prescribed to them during labor, have had their children removed by child welfare authorities who viewed these women as somehow violating a contractual or legal relationship to their unborn children.59 This is true in spite of the fact that not a single state, including South Dakota, has enough drug treatment available for all of the pregnant and parenting women who want and need it. 60
Finally, the earlier exampled of forced surgery over the objections of pregnant women, husbands and doctors has been the direct result of giving legitimacy to the idea of legal separation between pregnant women and the fetuses they carry.
This Task Force must recognize that to oppose the recognition of fetal personhood as a matter of law is not to deny the value and importance of potential life as matter of religious belief, emotional conviction, or personal experience. Rather, by rejecting such a new legal construct, the Task Force can improve both maternal and fetal health and ensure that no family ever had to endure the losses that Angela Carder's family suffered at the hands of the state, in the name of fetal rights.
Creating Doubt, Leaving Too Many Pregnant Women, Mothers Out
By focusing exclusively on abortion, the committee implies that the provision of health care to women who continue to term is more than adequate and closes its eyes to the many serious problems such women face in accessing fully voluntary and informed care. In fact, many women who are giving birth are not provided with essential information. For example, the World Health Organization considers acceptable levels for cesarean rates as not less than 5% and not more than 15% of all deliveries.61 Yet approximately 28% of all US births are by cesarean delivery, accounting for approximately one million cesareans.62 Some providers and hospitals have even higher rates. Nevertheless, South Dakota does not require health care providers to provide expectant parents with information about their c-section rates and related information, including rates of births using induction and births utilizing episiotomies.63 Such information is necessary in order for families to make informed decisions about which providers they will use for their deliveries.
Many hospitals have also instituted policies banning vaginal birth after cesarean (VBAC), "misleading women to believe they must undergo cesarean surgery whether there is a medical need for it or not." 64 Lack of attention to the ways in which pregnant women who continue to term are left uninformed or actually mislead suggests a lack of concern for the majority of pregnant women in the state. 65
By focusing only on abortion, these hearings also create the illusion that all pregnant women who choose to deliver their babies are not only provided with full information but also treated with care and respect. Yet, instances of poor communications, failure to inform, and even abuse are apparently so common in the birthing context that one organization has created a guide for filing complaints. The form begins by asking:
What do we do when obstetricians or other hospital staff have treated us rudely, abusively or violently? Do they ever hear from us afterward? Abusive behavior toward women, especially in childbirth, is unacceptable and harmful (can cause Post Traumatic Stress Syndrome). Abusive or unacceptable behavior can include threats, scolding, coercion, yelling, belittling, lying, manipulating, mocking, dismissing, refusing to acknowledge, treating without informed consent, omission of information, over-riding your refusal of a treatment, misrepresentation (of medical situation, of interventions, of reasons they "need" you to do something or not do something), etc. For a raised consciousness on this topic, read: Violence against women in health-care institutions: an emerging problem. by A. F.P.L. d'Oliveira, S.G. Diniz and L. B. Schraiber The Lancet, Vol. 359. May 11, 2002. 66
Moreover, a growing number of pregnant women in America are now giving birth inside jails and prisons, some delivering while shackled to their beds, others left to give birth or miscarry in a prison bathroom.67 A true commitment to all pregnant women and mothers would require investigation of all aspects of reproductive health care in all contexts, not just the care provided to women seeking to end their pregnancies.
Reproductive health care providers in general also often fail to provide women with essential information about the possibility of miscarriage and stillbirths. Even though miscarriages and stillbirths occur in as many as 15-20 percent of all pregnancies, ob/gyns and prenatal care providers rarely inform women of this risk or offer information that would help women prepare for and cope with this very common and very possible loss.68 South Dakota does not mandate such disclosure nor create mechanisms for training health care providers in how to convey this information or provide support through the process. The narrow focus of this Task Force again suggests a lack of concern for all pregnant women.
Earlier testimony also claimed that abortion providers fail to screen women for a history of sexual abuse and violence. Although it is unclear that any peer reviewed research finds any unique failure on the part of abortion providers in this regard, it is clear that raising this concern only on behalf of women seeking to end their pregnancies creates the disturbingly false impression that all other pregnant women and mothers are carefully screened and counseled. In fact numerous studies find that few physicians screen their patients for abuse. 69 A 1990 study published in the Journal of the American Medical Association found that only 10 percent of primary care physicians routinely screen for intimate partner abuse during patient visits.70 Again, I need to ask if this Task Force in fact wishes to ignore the needs of the majority of pregnant women who continue their pregnancies to term each year and potentially make their situation worse by creating the impression that somehow their health care and informational needs are being fully met?
Earlier today, a witness also suggested that the voluntary nature of abortion services should be doubted because some women obtaining abortions do not meet the person who will perform the procedure until a few minutes beforehand. Even if true, there is no research to suggest that this phenomenon in any way jeopardizes women's health or in any way undermines the informed consent process. What this argument does do however, is create another false impression; that other medical patients are getting better care and more individual attention from their physicians than the group selected for scrutiny by this panel - pregnant women seeking to end their pregnancies.
The United States remains the only western industrialized country not to have a national system of health insurance. 71 Forty-three million Americans, including eight and half million children, lack health care coverage.72 41 percent of women of childbearing age, who have incomes below the federal poverty level, do not have private health insurance or Medicaid.73 In South Dakota, 88,350 people are without health insurance, the equivalent of 12% of the state's population.74 Forty-one % of South Dakota's Indian youth reported having no health insurance; 21 % report having received no routine health care in the past two years. 75
In fact as the March of Dimes recently noted: "An extensive literature documents that many uninsured Americans do not receive necessary or appropriate medical care."76 Moreover, low-income pregnant women receiving publicly funded care often "go to overcrowded hospitals staffed by interns and residents who are overworked and insufficiently trained."77 Again it is necessary to ask why, given the pressing problems so many American's face in obtaining adequate prenatal and delivery services as well as a full range of other health care , the focus is on one procedure - abortion - that has been proven time and again to be safe, effective, and voluntary?
Finally, Dr. Rue argued that all women seeking abortion services should be required to submit to some kind of psychological evaluation. It is ironic that in a country where millions of Americans who desperately need mental health services cannot get them, the State of South Dakota is apparently considering requiring such services for a select group of women that do not by any evidence-based standard require such services. Indeed, South Dakota has chosen to provide only partial parity for insurance coverage of mental health services, leaving many South Dakotans who in fact need such services without coverage. 78
It is indeed ironic that this Task Force is focusing on an issue abortion that in fact has been extensively studied and shown time and again to be one of the most common and safest medical procedures in the United States today. The risk of abortion complications is minimal; less than 1% of all abortion patients experience a major complication.79 The risk of death associated with childbirth is about 11 times as high as that associated with abortion.80
Lacking scientific or medical evidence of its danger or harm, those opposed to abortion as a matter of religious or personal convictions must resort to the strategy of creating doubt. Posing questions such as "Are abortion decisions really voluntary?" and suggesting that not enough research has been done to demonstrate the safety and efficacy of abortion services is a strategy with fascinating parallels to the effort to undermine environmental protections. There, in the face of overwhelming evidence of human contribution to global warming, opponents of environmental protection and regulation create doubt about the extensive science establishing the relationship between human behavior and environmental hazards.
The questions that this Task Force is considering do not focus on pregnant women and mothers as life and caregivers - but rather only as people who "terminate" or abandon their "unborn children." This focus distracts attention from the profound debt America owes to its pregnant women and mothers. American women - many of whom at some point in their lives have had or will have abortions - "do 80 percent of the child care and two-thirds of the housework."81 They do this work without any form of formal compensation, without any guaranteed pensions, and without any form of insurance or healthcare should they need it. Economists suggest that if Americans had to pay for the volunteer and unpaid labor that America's pregnant women and mothers do, we would go bankrupt.
We claim to be a culture of life - but that has little meaning when the primary way we value the women who give that life is to portray them as incompetent decision makers and limit their access to abortion services. If we truly love and respect our mothers we will address the range of health and economic issues they really do harm them and their children. Suggesting that they cannot make decisions or that they need to be supervised by courts or psychiatrists says yet again to America's pregnant women and mothers We do not value you or the work you do. South Dakota has the opportunity to send a different message: We take mothers and parenthood seriously, and our next hearings will be about how to ensure that you have the health insurance, economic security, and access to educational resources that you and your family need.